腱鞘巨細(xì)胞瘤

1、腱鞘巨細(xì)胞瘤的MRI表現(xiàn),腱鞘巨細(xì)胞瘤giant cell tumor of the tendon sheatLiuzhenghua,好發(fā)部位,手部，足部，踝關(guān)節(jié)，腕關(guān)節(jié)，膝關(guān)節(jié)來源于滑膜,好發(fā)年齡,常見于于20～50歲的成年人．也可見于老年和青少年，但兒童罕見，女性略高發(fā)。,病因,外傷或多次的輕外傷（repeated micro trauma）,病理學(xué)表現(xiàn),由充滿含鐵血黃素的單核組織細(xì)胞（泡沫細(xì)胞）、多核巨細(xì)胞膠原纖維

2、基質(zhì)豐富的毛細(xì)血管,Haematoxylin and eosin-stained section of GCTTS (200×) showing sheets of ovoid fibrohistiocystic cells and scattered osteoclast-like giant cells.,,Microscopic picture of the lesion showing giant cells wit

3、hproliferation of fibroblasts. Foam cell could be seen.,分型,有局限型與彌散型。局限型病灶形態(tài)相似，均為圓形或卵圓形，邊界較清。常見于手與足部。彌散型均分布彌散，呈多發(fā)結(jié)節(jié)，較多伴關(guān)節(jié)積液。彌漫性、浸潤性生長，主要發(fā)生在關(guān)節(jié)外。,,臨床表現(xiàn),軟組織腫塊漸進(jìn)性增大關(guān)節(jié)腫脹或疼痛行走不便可觸摸到軟組織腫塊,臨床表現(xiàn),X線平片及CT表現(xiàn),關(guān)節(jié)周圍彌漫性軟組織增厚，大多可見邊

4、緣性骨質(zhì)破壞，破壞區(qū)邊界清楚，可見硬化邊。破壞區(qū)周圍無骨膜反應(yīng)。軟組織腫塊內(nèi)無鈣化或骨化征象。受累關(guān)節(jié)通常無骨質(zhì)疏松，關(guān)節(jié)間隙通常無明顯變窄。,MRI信號(hào)特征,實(shí)性成分：等長T1混雜T2信號(hào)。囊性成分：等長T1長T2信號(hào)。增強(qiáng)：實(shí)性成分中等或重度程度強(qiáng)化。,MRI信號(hào)特征,含鐵血黃素沉積：T1WI及T2WI上為低信號(hào)。膠原纖維：T1WI及T2WI稍高于骨骼肌信號(hào)。,Sagittal T2-weighted FSE and c

5、oronal (B,left) pre- and (C, right) post-i.v. Gad-DTPA fat suppressed 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

6、T2-weighted FSE MR images.,a central area of higher signal intensity (arrowheads) and a larger peripheral rim (arrows) of markedly decreased signal intensity.hemosiderin,A sagittal T2-weighted MRI image of the thumbsho

7、ws 2 separated subcutaneous masses without connection(*distal, **proximal). The masses are relatively welldemarcated from the surrounding tissue.,侵襲性表現(xiàn),可有鄰近軟骨、骨質(zhì)及韌帶破壞。骨質(zhì)破壞為腫瘤壓迫性改變。,PVNS（色素沉著絨毛結(jié)節(jié)性滑膜炎）,相同點(diǎn)：兩者M(jìn)RI信號(hào)特點(diǎn)相同，

8、都有含鐵血黃素長TI短T2低信號(hào)結(jié)節(jié)影，TI基本以等低信號(hào)為主，T2以低信號(hào)為主混雜信號(hào)；兩者都可破壞肌腱、韌帶及骨組織。,不同點(diǎn)：,，,refences,1. 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 nodula

9、rsynovitis of the foot and ankle. The Foot 13 (2003) 19–29. 2. Jong Woong Park, Multiple separated giant cell tumors of thetendon sheath in a thumb. AM ACAD DERMATOLMARCH 2006: 540-542.3. Jelinek JS, Kransdorf MJ, Shm

10、ookler BM, Aboulafia AA, Malawer MM. Giant cell tumour of tendon sheath: MR imaging findings in nine cases. Am J Roentgenol 1994;162:919–22.4. Mohie Eldin Fadel, Axel Schulz, Ralph Linker, Jorg Jerosch.Giant cell tumour