CAJ | 학술논문

目的总结腹盆部炎性肌纤维母细胞瘤(IMT)的影像征象，并与病理相对照，以期提高该病的术前诊断准确率。材料与方法回顾性分析经手术病理证实的8例腹盆部IMT，其中男5例，女3例，年龄38～78岁，平均年龄54岁。临床表现为腹部疼痛或肝区痛3例，无明显诱因消瘦2例，体检发现3例。术前7例行CT检查，3例同时行MRI检查。复习影像征象并与病理对照。结果肝脏5例，膀胱1例，肠系膜1例，肾脏1例，其中3例边界清晰，5例边界模糊；病灶大小不一，最大横径12～140 mm。CT平扫呈不均匀等低密度，MRI实性部分T1WI呈稍低信号，T2WI呈稍高信号，中心可见不规则坏死区，增强扫描强化方式各异：4例呈环形强化，3例呈轻度边缘强化，3例呈渐进性强化。病理特征：瘤体大部分呈实性或息肉样肿块；光镜示肿瘤组织由增生的纤维母细胞、肌纤维母细胞和炎症细胞构成，其中可见大量的浆细胞、淋巴细胞浸润，细胞无明显异型性，核分裂象少见。免疫组化显示Vimentin (6/6)、SMA (7/7)均为强阳性表达，ALK(1/8)及CD-68(2/8)为部分阳性表达，其他标记物S-100、CD117和CD34表达阴性。结论 CT及MRI检查对IMT的定位和定性诊断及鉴别诊断具有一定的价值，仔细分析其强化方式有望提出倾向性诊断，但IMT的确诊有赖于组织病理学及免疫组织化学检查。
목적총결복분부염성기섬유모세포류(IMT)적영상정상，병여병리상대조，이기제고해병적술전진단준학솔。재료여방법회고성분석경수술병리증실적8례복분부IMT，기중남5례，녀3례，년령38～78세，평균년령54세。림상표현위복부동통혹간구통3례，무명현유인소수2례，체검발현3례。술전7례행CT검사，3례동시행MRI검사。복습영상정상병여병리대조。결과간장5례，방광1례，장계막1례，신장1례，기중3례변계청석，5례변계모호；병조대소불일，최대횡경12～140 mm。CT평소정불균균등저밀도，MRI실성부분T1WI정초저신호，T2WI정초고신호，중심가견불규칙배사구，증강소묘강화방식각이：4례정배형강화，3례정경도변연강화，3례정점진성강화。병리특정：류체대부분정실성혹식육양종괴；광경시종류조직유증생적섬유모세포、기섬유모세포화염증세포구성，기중가견대량적장세포、림파세포침윤，세포무명현이형성，핵분렬상소견。면역조화현시Vimentin (6/6)、SMA (7/7)균위강양성표체，ALK(1/8)급CD-68(2/8)위부분양성표체，기타표기물S-100、CD117화CD34표체음성。결론 CT급MRI검사대IMT적정위화정성진단급감별진단구유일정적개치，자세분석기강화방식유망제출경향성진단，단IMT적학진유뢰우조직병이학급면역조직화학검사。
Objective: To conclude CT and MR image features of the inlfammatory myofibroblastic tumor of Abdominal-Pevic, and compare with pathology, in order to improve the preoperative diagnostic accuracy of the disease. Materials and Methods:Eight cases with IMT of Abdominal-Pevic conifrmed by surgery pathology were retrospectively analyzed including 5 males and 3 females, age from 38 to 78 years, mean age 54 years. Clinical manifestation was abdominal pain, or liver area pain (3 cases), no obvious cause angular in 2 cases, 3 cases were found by medical examination. Among 8 cases, 7 underwent CT scanning, while the 3 cases underwent both CT and MRI examination. To review the imaging signs and compare with pathology. Results:Each 1 case located in bladder, mesenterium, and kidney, 5 cases located in liver. 5 cases had ill-deifned margin. Plain CT showed the uneven density with the 8 cases, in MR, the tumor showed iso-hypointensity on T1WI and slightly iso-hyperintensity on T2WI. They showed variable patterns of contrast enhancement:4 cases showed ring-shaped enhancement, 3 cases showed mild edge enhancement, 3 case showed gradual enhancement. Microscopically, the tumor were mainly composed of spindle shaped ifbrous cells and inlfammatory cells (mainly plasma cells and lymphocyte). Cells had no manifest heteromorphism. Immunohistochemically, Vimentin (6/6) and SMA (7/7) were positive in all the cases, ALK (1/8) and CD-68 (2/8) were partly positive expression, other markers such as S-100, CD117, CD34 were negative expression. Conclusions:CT and MR had the value for the localization and qualitation diagnosis and differential diagnosis of IMT, careful analysis of the enhancement is expected to propose propensity diagnosis. But the deifnite diagnose relies on pathological and immunohistochemical study.