巨细胞修复性肉芽肿.ppt

Nonspecific findings of cortical thinning and softtissue extension have been described at CT, and lesion attenuation is similar to that of muscle (9,123,124). In our experience, as in GCT, these lesions have low to intermediate signal intensity at both T1- and T2-weighted MR imaging (Fig 12). Compared with GCT, cystic areas (ABC components) are less common and typically constitute only small components. Curettage is used to treat GCRG. Recurrence is seen in 22%–50% of cases, although lesion eradication typically does not require more than two excisions (113,121). To our knowledge, sarcomatous transformation or aggressive lesional spread has not been described. * 病例一 男性，44岁，发现左颞部肿物伴头晕半年 半年前无意中发现左颞部肿物，稍突出头皮，伴间断头晕、闷胀感，未诊治，后症状渐重来院就诊。起病以来体重减轻4kg 既往左耳听力下降3年，外院诊断“中耳炎”，现左耳听力基本消失。 查体：CNS（-） 外院CT：左颞部肿块内见多发钙化（无片） T2W T1W FS FLAIR DWI b=1000 T2W Gd-DTPA T1W 脑膜瘤？ 血管外皮瘤？ 畸形性骨炎（Paget 病）？ 骨纤维异常增殖症？ 软骨肉瘤？ 巨细胞修复性肉芽肿？ 骨巨细胞瘤？ 手术记录 肿物位于颞肌下方，颞骨破坏，约鸡蛋大小，表面光滑，界限清楚，质韧，血运丰富 肿物位于硬膜外，将颞叶压向中颅窝底 肿瘤包膜厚约0.5cm，包膜内大量豆腐渣样内容物 病理 左颞部“巨细胞瘤”，请结合临床除外棕色瘤 补查：血钙及PTH未见异常，除外棕色瘤 巨细胞修复性肉芽肿Giant cell reparative granuloma, GCRG 真性骨巨细胞瘤Giant cell tumor of bone, GCT 颅骨“巨细胞瘤” GCT 膨胀性、地图样溶骨性骨质破坏 无硬化缘 无成骨，仅有残存骨嵴 一般无骨膜反应 恶性征象：1.骨质破坏加速，呈虫蚀样或筛孔样；2.皮质断裂或局部消失，移行带增宽；3.软组织肿块巨大；4.出现骨膜反应。 杜湘珂，朱绍同，骨与软组织肿瘤影像诊断及鉴别诊断，北京大学出版社，2007 GCRG 非真性肿瘤，不恶变，多无复发、预后好 可能与外伤或感染相关，具体机制不清 影像学表现缺乏特异性 MR：T1W和T2WI均为低信号为主 GCRG囊变相对少且范围小 常可见肿物内钙化 需结合临床除外棕色瘤 病理学与GCT重叠，需结合临床最后判别 Murphey et al. Imaging of Giant Cell Tumor and Giant Cell Reparative Granuloma of Bone: Radiologic-Pathologic Correlation. RadioGraphics 2001; 21:1283–1309 Nonspecific findings of cortical thinning and softtissue extension have been described at CT, and lesion attenuation is similar to that of muscle (9,123,124). In our experience, as in GCT, these lesions have low to intermediate signal intensity at both T1- and T2-weighted MR imaging (Fig 12). Compared with GCT, cystic areas (ABC components) are less common and typically constitute only small components. Curettage