神經影像（七十四）後腹膜腔的孤立性纖維瘤

10.6666/ClinMed.201811_82(5).0128

潘慧本

後腹膜腔腫瘤（retroperitoneal tumor） ； 孤立性纖維瘤（solitary fibrous tumor, SFT） ； 原發性肝細胞癌（hepatocellular carcinoma, HCC）

臨床醫學月刊

82卷5期（2018 / 11 / 30）

696 - 703

繁體中文

在偶爾的機會，病患發現了後腹膜腔有一個腫瘤，影像學上面表現是邊緣完整明確，有一個包囊，但是腫瘤本身的血管卻不豐富、顯影不明顯、沒有壞死、沒有鈣化、沒有出血、但是有很明顯的粘液樣變性。病理結果為孤立性纖維瘤（solitary fibrous tumor, SFT），非典型粘液樣孤立性纖維瘤伴有脂肪形成細胞（atypical myxoid solitary fibrous tumor with fat-forming cells）。有或沒有脂肪雖然對於SFT預後是沒有什麼影響，但是病理學上需要做鑑別診斷。這個腫瘤雖然有脂肪的成份，但是所有影像包括磁振造影（magnetic resonance imaging, MRI）卻偵測不出來它是一個含有脂肪的腫瘤，因此影像學上一點都沒有懷疑脂肪肉瘤。SFT的影像學表現原則上是與病理的表現相一致，腫瘤內部的表現，則依不同的病理型態，而有不同的影像呈現。基本上腫瘤內的細胞多，血管就會豐富，細胞不多，顯影血管就不豐富。因此若有類似間質瘤，但是注射對比劑後腫瘤增強不佳，T2WI訊號雖亮，但是並不均勻，黑白交錯，就要考慮低細胞表型（hypocellular phenotype, Fibrous SFT）粘液樣變性這一方面的腫瘤。SFT並不常見轉移，肝臟的病灶，仍然需要考慮是原發性的肝細胞癌。

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