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中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (06) : 879 -883. doi: 10.3877/cma.j.issn.1674-134X.2018.06.024

所属专题: 文献

临床经验

四肢孤立性纤维瘤的诊断及外科治疗
蔡志清1, 李登1, 许杰1, 苏保华1, 马若凡1,()   
  1. 1. 510120 广州,中山大学孙逸仙纪念医院关节外科
  • 收稿日期:2017-12-13 出版日期:2018-12-01
  • 通信作者: 马若凡
  • 基金资助:
    广东省自然科学基金项目(2018A030310231); 中央高校基本科研业务费专项资金资助(18zxxt61); 广州市科技计划项目(201803010011); 广东省科技计划项目(2014A020212060,2014A020215009)

Diagnosis and surgical treatment for solitary fibrous tumor limbs

Zhiqing Cai1, Deng Li1, Jie Xu1, Baohua Su1, Ruofan Ma1,()   

  1. 1. Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
  • Received:2017-12-13 Published:2018-12-01
  • Corresponding author: Ruofan Ma
  • About author:
    Corresponding author: Ma Ruofan, Email:
引用本文:

蔡志清, 李登, 许杰, 苏保华, 马若凡. 四肢孤立性纤维瘤的诊断及外科治疗[J/OL]. 中华关节外科杂志(电子版), 2018, 12(06): 879-883.

Zhiqing Cai, Deng Li, Jie Xu, Baohua Su, Ruofan Ma. Diagnosis and surgical treatment for solitary fibrous tumor limbs[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(06): 879-883.

目的

探讨四肢孤立性纤维瘤(SFT)的临床表现、影像学特点及病理学特征、手术治疗方式。

方法

回顾性分析中山大学孙逸仙纪念医院关节外科9例经病理确诊的四肢孤立性纤维瘤患者的临床表现、影像学特点及病理学特征。9例患者中3例男性,6例女性,中位数年龄44岁(15~55岁);均进行MRI检查,手术切除后送病检行免疫组化,比较其临床表现、影像学特征及病理学特征。

结果

9例患者中,肿瘤分布于上肢者6例,下肢3例。患者首要临床症状均为无痛性肿块,其中3例出现患肢远端麻木等压迫症状。影像学方面,9例患者术前行MR检查,了解其边界及邻近关系,7例患者MR表现为T1加权像为等信号,2例为低信号;T2加权像4例为混杂高信号,1例为高信号;9例患者增强像为不均匀明显强化;边界清楚者6例,模糊者3例。免疫组化结果显示9例患者中波形蛋白(vimentin)均为阳性(9/9),跨膜糖蛋白分子CD34阳性者8例(8/9); B淋巴细胞瘤-2因子(bcl-2)阳性者6例(6/9),信号转导与转录激活因子-6(STAT-6)阳性者3例(3/9);增殖细胞相关核抗原Ki67分布于5%~65%。

结论

影像学中MRI通过不同加权像可以对SFT的瘤体边界进行定位,确定肿瘤的邻近关系,为SFT的诊断提供依据,为手术方案的选择提供依据。进行病理学免疫组化是诊断孤立性纤维瘤的主要手段,并可指导术后辅助放化疗方案的制定。

Objective

To investigate the clinical feature s of solitary fibrous tumor (SFT) in limbs and the optimal surgical approaches effect.

Methods

The clinical records of nine patients with SFT in limbs were retrospectively reviewed in department of orthopaedics of Sun Yat-sen Memorial Hospital between January 2005 and December 2016. There were three males and six females, with a median age of 44 years (15~55 years). Laboratory examinations showed normal results. MRI and biopsy were performed in all the cases. All the patients underwent surgical treatment with resection performed. The tumors originated from up libms in six patients, from lower limbs in three patients.

Results

All the tumors were totally excised. There was no postoperative mortality nor major complications. Among the nine patients, six patients had tumors in the upper extremities and three in the lower extremities. The primary clinical symptoms were painless masses, three of them with the distal limb numbness symptoms of compression. All the patients accepted MRI examinations to analyse their connections, confirm the borderline and size of the diseased tissues and its relation to the adjacent tissues. MRI examinations demonstrated that appearances of lesions were various. The expressions of vimentin(nine cases), CD348(eight cases), bcl-2(six cases), signal transducers and activators of transcription(STAT)-6(three cases) and Ki67(5% to 65%) were positive by immunohistochemical analysis.

Conclusions

MRI can be used to survey the tumor boundary of SFT, determine the adjacent relationship of SFT, provide the proofs for the diagnosis of SFT, and provide the basis for the selection of surgical procedures. Pathological immunohistochemistry is the main method for the diagnosis of solitary fibroma and can guide the formulation of adjuvant radiotherapy and chemotherapy after operation.

表1 9例患者病灶组织的MRI表现
图1 良性孤立性纤维瘤的MRI表现,示病变边缘光滑,其内多发包囊及线样分隔,并可见血管走行其内,病灶边缘光滑,病灶信号不均匀。图A为T1WI图像,示病灶呈低信号;图B为T2WI图像,示病灶呈高信号;图C为WAVE图像,示病灶呈高信号,增强较均匀
表2 9例患者的病理表现
图2 恶性孤立性纤维瘤MRI表现,肿块边缘不清晰,周围组织可见水肿带。图A为T1WI图像,示病灶呈等长T1信号;图B为T2WI图像,示混杂长T2信号;图C为WAVE图像,示增强扫描不均匀明显强化,中央可见多发斑片状坏死区,边缘模糊
图3 良恶性孤立性纤维瘤的HE(苏木素-伊红)染色,×100。图A为良性纤维瘤,示细胞狭长,呈旋涡状排列,紧密不一;图B为恶性纤维瘤,示细胞核异型性明显
[1]
Cruz CP, de Castro CJ. Malignant solitary fibrous tumour of the pleura: an uncommon entity[J]. Arch Bronconeumol, 2015, 51(7): 362-363.
[2]
Jadczak P, Guz W, Kaznowska E, et al. Solitary fibrous tumour of the pleura-cases analysis[J]. Pol J Radiol, 2014, 79: 368-373.
[3]
Ali JM, Ali A, Van Leuven M, et al. Giant solitary fibrous tumour of the pleura an unpredictable entity: case series and literature review[J]. Ann R Coll Surg Engl, 2017, 99(6): E165-E171.
[4]
Zheng LD, Mccluskey P, Ghabrial R. Largest reported orbital solitary fibrous tumour[J]. Clin Exp Ophthalmol, 2018, 46(3): 301-303.
[5]
Grech N, Ellul E, Spiteri N, et al.Solitary fibrous tumour: a rare cause of acute abdomen[J/OL]. Ann Ital Chir, 2017, 6. pii: S2239253X17026767.
[6]
Dungarwalla MM, Barrett AW, Gulati A. Solitary fibrous tumour of the tongue: a series of four cases[J]. J Laryngol Otol, 2017, 131(9): 838-841.
[7]
Kalebi AY, Hale MJ, Wong ML, et al. Surgically cured hypoglycemia secondary to pleural solitary fibrous tumour: case report and update review on the Doege-Potter syndrome[J/OL]. J Cardiothorac Surg, 2009, 4(1): 45. doi: 10.1186/1749-8090-4-45.
[8]
Klemperer P, Coleman BR. Primary neoplasms of the pleura. A report of five cases[J]. Am J Ind Med, 1992, 22(1): 1-31.
[9]
Balduyck B, Lauwers P, Govaert K, et al. Solitary fibrous tumor of the pleura with associated hypoglycemia: Doege-Potter syndrome-a case report[J]. J Thorac Oncol, 2006, 1(6): 588-590.
[10]
Baxter AR, Newman E, Hajdu CH. Solitary fibrous tumor of the pancreas[J/OL]. J Surg Case Rep, 2015, 2015(12). pii: rjv144. doi: 10.1093/jscr/rjv144.
[11]
Brenes J, Moreno A, Jesus Merchan M, et al. Solitary fibrous tumor of the breast: a rare neoplasm[J]. Breast J, 2018, 24(3): 417-419.
[12]
Rodrigues RM, Fernandes AO, de Oliveira SP, et al. Solitary fibrous tumor of the floor of the mouth[J/OL]. J Clin Exp Dent, 2017, 9(9):e1153-e1157. doi: 10.4317/jced.53492.
[13]
Smith SC, Gooding WE, Elkins M, et al. Solitary fibrous tumors of the head and neck: a multi-institutional clinicopathologic study[J]. Am J Surg Pathol, 2017, 41(12): 1642-1656.
[14]
Espat NJ, Lewis JJ, Leung D, et al. Conventional hemangiopericytoma: modern analysis of outcome[J]. Cancer, 2002, 95(8): 1746-1751.
[15]
Ahmad GE, Athavale R, Hamid BN, et al. Pelvic malignant hemangiopericytoma mimicking an ovarian neoplasm-a case report[J]. J Reprod Med, 2004, 49(5): 404-407.
[16]
Hoshino M, Ogose A, Kawashima H, et al. Malignant solitary fibrous tumor of the soft tissue: a cytogenetic study[J]. Cancer Genet Cytogenet, 2007, 177(1): 55-58.
[17]
Fletcher CD. The evolving classification of soft tissue tumours -an update based on the new 2013 WHO classification[J]. Histopathology, 2014, 64(1): 2-11.
[18]
Horton ES, Dobin SM, Donner LR. A clonal t(8;12)(p11.2;q24.3) as the sole abnormality in a solitary fibrous tumor of the pleura[J]. Cancer Genet Cytogenet, 2007, 172(1): 77-79.
[19]
Bertero L, Anfossi V, Osella-Abate SA, et al. Pathological prognostic markers in central nervous system solitary fibrous tumour/hemangiopericytoma: evidence from a small series[J/OL]. PLoS One, 2018, 13(9): e203570. doi: 10.1371/journal.pone.0203570.
[20]
Jawad MU, Scully SP. In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system[J]. Clin Orthop Relat Res, 2010, 468(7): 2000-2002.
[21]
Wada T, Kawai A, Ihara K, et al. Construct validity of the Enneking score for measuring function in patients with malignant or aggressive benign tumours of the upper limb[J]. J Bone Joint Surg Br, 2007, 89(5): 659-663.
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