课件：脂肪肉瘤-.ppt

Ganglion 腱鞘囊肿 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 ??? Well-differentiated liposarcoma can have an appearance similar to lipoma in 4 to 9% of cases. Ohguri et al1 and Hosono et al2 have suggested that prominent contrast enhancement of the septa on MR imaging suggests well-differentiated liposarcoma as opposed to lipoma, which may aid in distinction in these cases. Lipomatous lesions in the retroperitoneal should always be considered a liposarcoma regardless of the intrinsic imaging appearance 1. Ohguri T, Aoki T, Hisaoka M, et al. Differential diagnosis of benign peripheral lipoma from well-differentiated liposarcoma on MR imaging: is comparison of margins and internal characteristics useful? AJR Am J Roentgenol 2003;180(6):1689–1697 2. Hosono M, Kobayashi H, Fujimoto R, et al. Septum-like structures in lipoma and liposarcoma: MR imaging and pathologic correlation. Skeletal Radiol 1997;26(3):150–154 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. What else can radiologists do ? Dedifferentiated Liposarcoma(DDLS) Dedifferentiated liposarcoma arises within a well-differentiated lesion, representing a biphasic tumor. The nonadipose component is typically a high-grade cellular sarcoma (often MFH or fibrosarcoma). * Dedifferentiation occurs in ~10% of WDLS, and the incidence depends on lesion location. The estimated risk of dedifferentiation for deep-seated extremity lesions