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1、腱鞘巨细胞瘤的MRI表现,腱鞘巨细胞瘤 giant cell tumor of the tendon sheat Liuzhenghua,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
2、ovoid fibrohistiocystic cells and scattered osteoclast-like giant cells.,Microscopic picture of the lesion showing giant cells with proliferation 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。,临床表现,软组织肿块渐进性增大 关节肿胀或疼痛
3、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。,Sagittal T2-weighted FSE and coronal (B,left) pre- and (C, ri
4、ght) 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) STIR and (C) axial T2-weighted FSE MR images.,a central area of higher signal intensity (arrowheads) and a larger peripheral rim (a
5、rrows) of markedly decreased signal intensity. hemosiderin,A sagittal T2-weighted MRI image of the thumb shows 2 separated subcutaneous masses without connection (*distal, *proximal). The masses are relatively well demarcated 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
6、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. Davies MRI of giant cell tumour of ten
7、don sheath and nodularsynovitis of the foot and ankle. The Foot 13 (2003) 1929. 2. Jong Woong Park, Multiple separated giant cell tumors of the tendon 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,