脂肪肉瘤教材教学课件.ppt

早读片2015-07-31; 女 61岁 Patient ID ;主 诉：体检发现左侧胸腔占位一月余 入院情况：患者一月前因咳嗽地热于外院查体发现左侧胸腔占位。患者目前无明显不适，无胸闷憋气，无咳嗽咳痰，无胸痛。 入院查体：左肺下叶呼吸音较对侧减弱。 既往史：高血压十余年，药物控制满意。 1971年急性阑尾炎，阑尾切除。 ;肿瘤标记物： CA125：41.8U/ml（0-35.0） NSE(神经元特异性烯醇化酶):17.3ng/ml(0-16.3) ProGRP（血清胃泌素释放肽前体）:56.0pg/ml(0-50);诊断及鉴别诊断;手术记录;病理结果;A similar case in the literature; World Health Organization Classification of Bone and Soft Tissue Tumors: Modifications and Implications for Radiologists Mark D. Murphey, M.D.;Classification;Well-differentiated Liposarcoma（WDLS）;Cross-sectional imaging of well-differentiated liposarcoma is frequently characteristic. CT and MR imaging reveal a lesion composed of 50 to 75% adipose tissue with additional prominent nonlipomatous components . The nonlipomatous components of the lesion commonly reveal thick ( 2 mm) and numerous septa or focal globular or nodular regions (typically 2 cm in size). （collagenized areas, metaplastic mineralization, fat necrosis…） ;Well-differentiated liposarcoma of the distal thigh in a 65-year-old woman. CT , sagittal T1-WI, and sagittal T2-WI MR images show a largely lipomatous soft tissue mass (arrows) with prominent nonlipomatous components seen as irregular thick septae and globular regions (arrowheads) typical of well-differentiated liposarcoma.; For radiologists;Biopsy of extremity lesions is often fraught with uncertainty, owing to the large size and heterogeneity of these lesions and possibility of not obtaining diagnostic tissue to allow differentiation from lipoma. Imaging may be helpful to direct biopsy to more nonlipomatous regions, allowing more confident pathological diagnosis.;Dedifferentiated Liposarcoma(DDLS);Dedifferentiation occurs in ~10% of WDLS, and the incidence depends on lesion location. The estimated risk of dedifferentiation for deep-seated extremity lesions is ~5%. The estimated risk of dedifferentiation in retroperitoneal lesions is 15% and much higher than other locations. （It has been suggested that th