腱鞘巨细胞瘤课件VIP免费

腱鞘巨细胞瘤的MRI表现腱鞘巨细胞瘤giantcelltumorofthetendonsheatLiuzhenghua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20～50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（repeatedmicrotrauma）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Haematoxylinandeosin-stainedsectionofGCTTS(200×)showingsheetsofovoidfibrohistiocysticcellsandscatteredosteoclast-likegiantcells.Microscopicpictureofthelesionshowinggiantcellswithproliferationoffibroblasts.Foamcellcouldbeseen.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。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。SagittalT2-weightedFSEandcoronal(B,left)pre-and(C,right)post-i.v.Gad-DTPAfatsuppressedT1-weightedSEMRimages.Axial(A,top)T2-weightedFSE(B,middle)pre-and(C,bottom)post-i.v.Gad-DTPA(A)T1-weighted,(B)STIRand(C)axialT2-weightedFSEMRimages.acentralareaofhighersignalintensity(arrowheads)andalargerperipheralrim(arrows)ofmarkedlydecreasedsignalintensity.hemosiderinAsagittalT2-weightedMRIimageofthethumbshows2separatedsubcutaneousmasseswithoutconnection(*distal,**proximal).Themassesarerelativelywelldemarcatedfromthesurroundingtissue.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；•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。refences•1.O.Harris,D.A.Ritchie,R.Maginnis,G.R.Lamba,T.Helliwell,M.Jane,A.M.DaviesMRIofgiantcelltumouroftendonsheathandnodularsynovitisofthefootandankle.TheFoot13(2003)19–29.•2.JongWoongPark,Multipleseparatedgiantcelltumorsofthe•tendonsheathinathumb.AMACADDERMATOLMARCH2006:540-542.•3.JelinekJS,KransdorfMJ,ShmooklerBM,AboulafiaAA,MalawerMM.Giantcelltumouroftendonsheath:MRimagingfindingsinninecases.AmJRoentgenol1994;162:919–22.•4.MohieEldinFadel,AxelSchulz,RalphLinker,JorgJerosch.Giantcelltumourofthetendonsheathinthefoot.FootandAnkleSurgery12(2006)33–37