腱鞘巨细胞瘤课件.ppt

1、腱鞘巨细胞瘤的MRI表现腱鞘巨细胞瘤giant cell tumor of the tendon sheatLiuzhenghua好发部位 手部，足部，踝关节，腕关节，膝关节来源于滑膜好发年龄 常见于于2050岁的成年人 也可见于老年和青少年，但儿童罕见，女性略高发。病因 外伤或多次的轻外伤（repeated micro trauma）病理学表现 由充满含铁血黄素的单核组织细胞（泡沫细胞）、多核巨细胞 胶原纤维基质 丰富的毛细血管Haematoxylin and eosin-stained section of GCTTS(200)showing sheets of ovoid fibrohi

2、stiocystic cells and scattered osteoclast-like giant cells.Microscopic picture of the lesion showing giant cells withproliferation of fibroblasts.Foam cell could be seen.分型 有局限型与弥散型。局限型病灶形态相似，均为圆形或卵圆形，边界较清。常见于手与足部。弥散型均分布弥散，呈多发结节，较多伴关节积液。弥漫性、浸润性生长，主要发生在关节外关节外。临床表现 软组织肿块渐进性增大 关节肿胀或疼痛 行走不便 可触摸到软组织肿块临床表

3、现 X线平片及CT表现 关节周围弥漫性软组织增厚，大多可见边缘性骨质破坏，破坏区边界清楚，可见硬化边。破坏区周围无骨膜反应。软组织肿块内无钙化或骨化征象。受累关节通常无骨质疏松，关节间隙通常无明显变窄。MRI信号特征 实性成分：等长T1混杂T2信号。囊性成分：等长T1长T2信号。增强：实性成分中等或重度程度强化。MRI信号特征 含铁血黄素沉积：T1WI及T2WI上为低信号。胶原纤维：T1WI及T2WI稍高于骨骼肌信号。Sagittal T2-weighted FSE and coronal(B,left)pre-and(C,right)post-i.v.Gad-DTPA fat suppres

4、sed T1-weighted SE MR images.Axial(A,top)T2-weighted FSE(B,middle)pre-and(C,bottom)post-i.v.Gad-DTPA(A)T1-weighted,(B)STIRand(C)axial T2-weighted FSE MR images.a central area of higher signal intensity(arrowheads)and a larger peripheral rim(arrows)of markedly decreased signal intensity.hemosiderinA

5、sagittal T2-weighted MRI image of the thumbshows 2 separated subcutaneous masses without connection(*distal,*proximal).The masses are relatively welldemarcated from the surrounding tissue.侵袭性表现 可有邻近软骨、骨质及韧带破坏。骨质破坏为肿瘤压迫性改变。PVNS（色素沉着绒毛结节性滑膜炎）相同点：两者MRI信号特点相同，都有含铁血黄素长TI短T2低信号结节影，TI基本以等低信号为主，T2以低信号为主混杂信号

6、；两者都可破坏肌腱、韧带及骨组织。不同点：好发部位不同，GCTTS好发于四肢远端及小关节 PVNS好发于膝、髋、踝关节等大关节 GCTTS是发生在关节外滑膜病变，PVNS为关节内病变。refences1.O.Harris,D.A.Ritchie,R.Maginnis,G.R.Lamba,T.Helliwell,M.Jane,A.M.Davies MRI of giant cell tumour of tendon sheath and nodularsynovitis of the foot and ankle.The Foot 13(2003)1929.2.Jong Woong Park,M

7、ultiple separated giant cell tumors of thetendon sheath in a thumb.AM ACAD DERMATOLMARCH 2006:540-542.3.Jelinek JS,Kransdorf MJ,Shmookler BM,Aboulafia AA,Malawer MM.Giant cell tumour of tendon sheath:MR imaging findings in nine cases.Am J Roentgenol 1994;162:91922.4.Mohie Eldin Fadel,Axel Schulz,Ralph Linker,Jorg Jerosch.Giant cell tumour of the tendon sheath in the foot.Foot and Ankle Surgery 12(2006)3337