MR features and pathological basis of localized tenosynovial giant cell tumor in hands and feet
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摘要:
目的 探讨手足部局限性腱鞘巨细胞瘤的MR表现及其病理学基础。 方法 回顾性分析2018年4月~2022年7月在南方医科大学第三附属医院就诊、病理证实为手足部局限性腱鞘巨细胞瘤10例患者资料，男、女各5例，中位年龄26.5岁，均行术前MR检查、术后病理学检查。由2位经验丰富的医师共同阅读MR图像，观察病变的位置、形态、大小、边界、信号特点、累及范围、强化特点及骨质改变等，并分析其病理学基础。 结果 10例患者，肿物发生于手部、足部者分别为6例、4例。肿块呈分叶状、条状、梭形等，边缘清晰，轴位最大径约24 mm、延伸最长径约26 mm，在T1WI上均呈低或等信号，在T2WI上呈低或等信号为主，在PDWI以高信号者为主，大部分病灶(n=8)在各序列上均见条、片状低信号，呈轻、中度不均匀强化。邻近骨质受压改变3例，骨质侵蚀1例。病理学检查提示肿块质地硬实，主要由单核细胞组成，间见含铁血黄素等。 结论 手足部局限性腱鞘巨细胞瘤具有相对特异的MR表现，反映其病理学特征。 Abstract:Objective To investigate the MR features and pathological basis of localized tenosynovial giant cell tumor in hands and feet. Methods Ten patients with pathologically confirmed localized tenosynovial giant cell tumor in hands and feet in the Third Affiliated Hospital of Southern Medical University from April 2018 to July 2022 were retrospectively analyzed. The patients included 5 males and 5 females with a median age of 26.5 years. All patients underwent preoperative MR scanning and postoperative pathological examinations. MR findings of the lesions were analyzed by two experienced doctors, including the location, shape, size, boundary, signal intensity patterns, involvement range, enhancement patterns and bone abnormalities. The pathological basis of MR features was explored too. Results Six cases occurred in the hand and 4 cases in the feet of the 10 patients. The maximum axial diameter was about 24 mm, and the maximum extension diameter was about 26 mm. The lesions were hypo-or isointense at T1WI, mainly hypo-or isointense at T2WI, and mainly hyperintense at PDWI. Most of the lesions (n=8) showed strip or patchy hypointensity on all sequences, with mild to moderate inhomogeneous enhancement. Adjacent bone compressed was observed in 3 cases and bone eroded in 1 case. Pathological examinations showed that the masses were hard, mainly composed of mononuclear cells, and hemosiderin was seen between the cells. Conclusion Localized tenosynovial giant cell tumor in hands and feet shows relatively specific MR findings, which reflects its pathological features. -
Key words:
- tenosynovial giant cell tumor /
- magnetic resonance imaging /
- pathology
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图 1 患者女，36岁，发现左手肿物1月，局限性腱鞘巨细胞瘤
T2WI抑脂冠状位、T1WI冠状位、PDWI抑脂冠状位及T2WI轴位: 左手第5指近侧指间关节外侧肿块, 在T2WI及T1WI上呈等信号, 在T2WI压脂及PDWI压脂上呈略高信号, 各序列内部均可见条片状低信号. 另可见邻近的骨质受压改变.
Figure 1. A 36-year-old woman with a left hand mass for 1 month was diagnosed with localized tenosynovial giant cell tumor.
图 2 男，11岁，左足疼痛并局部肿胀2年，局限性腱鞘巨细胞瘤
T2WI冠状位、T1WI冠状位、PDWI抑脂冠状位及T1WI冠状位增强扫描: 左足第四、五趾间肿块, 在T2WI、T1WI及PDWI上均呈低信号, 增强扫描呈轻中度强化; 各序列内部均可见条片状更低信号影. 邻近的骨质未见异常改变.
Figure 2. An 11-year-old boy with pain and local swelling in his left foot for 2 years was diagnosed with localized tenosynovial giant cell tumor.
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[1] Kager M, Kager R, Fałek P, et al. Tenosynovial giant cell tumor[J]. Folia Med Cracov, 2022, 62(2): 93-107. [2] 郝婷婷, 熊晓亮, 宋晓良, 等. 色素沉着绒毛结节性滑膜炎99Tcm-MDP三相骨显像影像学表现: 3例病例报道并文献复习[J]. 中华核医学与分子影像杂志, 2020, 40(11): 686-8. doi: 10.3760/cma.j.cn321828-20191122-00268 [3] 王卫涛, 赵金康, 马兴. 26例膝关节色素沉着绒毛结节性滑膜炎治疗效果分析[J]. 中华全科医学, 2021, 19(12): 1991-4. doi: 10.16766/j.cnki.issn.1674-4152.002218 [4] 李伟华, 胡鹏, 毕树雄. 色素沉着绒毛结节性滑膜炎的研究进展[J]. 国际骨科学杂志, 2021, 42(1): 40-4. doi: 10.3969/j.issn.1673-7083.2021.01.010 [5] Vera E, Andersen Søren L, Ibrahim Q, et al. Tenosynovial giant cell tumor: incidence, prevalence, patient characteristics, and recurrence. A registry-based cohort study in Denmark[J]. J Rheumatol, 2017, 44(10): 1476-83. doi: 10.3899/jrheum.160816 [6] Lans J, Yue KL C, Castelein RM, et al. Benign hand tumors (part Ⅱ): soft tissue tumors[J]. Hand (N Y), 2022, 17(3): 519-28. doi: 10.1177/1558944720928499 [7] 王寻, 葛双, 孔钰, 等. 手掌腱鞘巨细胞瘤18F-FDG PET/CT显像1例[J]. 医学影像学杂志, 2022, 32(8): 1452-3. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ202208054.htm [8] 徐小丽, 王娟, 张娜, 等. 腱鞘巨细胞瘤与腱鞘纤维瘤超声表现分析[J]. 中国超声医学杂志, 2020, 36(6): 554-7. doi: 10.3969/j.issn.1002-0101.2020.06.022 [9] 杨小红, 李博雅, 李明智, 等. 色素沉着绒毛结节性滑膜炎与腱鞘巨细胞瘤的MRI特征及鉴别诊断[J]. 实用放射学杂志, 2019, 35(3): 426-9. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS201510029.htm [10] Lin F, Ionescu-Ittu R, Pivneva I, et al. The economic burden of tenosynovial giant cell tumors among employed workforce in the United States[J]. J Occup Environ Med, 2021, 63(4): e197-e202. doi: 10.1097/JOM.0000000000002159 [11] Mastboom MJL, Verspoor FGM, Verschoor AJ, et al. Higher incidence rates than previously known in tenosynovial giant cell tumors[J]. Acta Orthop, 2017, 88(6): 688-94. doi: 10.1080/17453674.2017.1361126 [12] 徐小丽, 王娟, 张娜, 等. 超声在局限型腱鞘巨细胞瘤诊断中的应用价值[J]. 中国超声医学杂志, 2020, 36(11): 1031-4. doi: 10.3969/j.issn.1002-0101.2020.11.023 [13] 李云华, 金利芳, 刘龙, 等. 手部局限性腱鞘巨细胞瘤常规超声特征[J]. 中国医学影像技术, 2022, 38(7): 1062-5. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX202207020.htm [14] 梁立锋, 赵娜, 崔文静, 等. 腱鞘巨细胞瘤的影像学表现[J]. 医学影像学杂志, 2020, 30(3): 528-31. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ202003053.htm [15] 王丽娜, 毕蕾, 陈阳. 手足部局限型腱鞘巨细胞瘤的影像表现[J]. 中国中西医结合影像学杂志, 2021, 19(4): 366-9. doi: 10.3969/j.issn.1672-0512.2021.04.016 [16] 蔡王莉, 郗艳, 魏小二, 等. 伴骨质改变的腱鞘巨细胞瘤的影像分析[J]. 临床放射学杂志, 2020, 39(2): 373-7. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS202002034.htm [17] 邓小丽, 王绍武, 高雪, 等. 不同病理类型腱鞘巨细胞瘤的MRI特点[J]. 中国医学影像技术, 2016, 32(6): 949-52. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201606036.htm [18] Thammaroj P, Chowchuen P, Sumananont C, et al. MRI findings of giant cell tumor of tendon sheath and other benign soft tissue tumors in hand[J]. J Med Assoc Thai, 2016, 99(7): 816-22. [19] Linney LS, Al-Hassani F, Pikturnaite J, et al. Tenosynovial giant cell tumours of the hand: a multicentre case-control study[J]. J Plast Reconstr Aesthet Surg, 2019, 72(6): 918-23. -
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