滑膜肉瘤影像英文ppt课件.ppt

ImagingofSynovialSarcomawithRadiologic PathologicCorrelation Synovialsarcomaisthefourthmostcommonmalignantprimarysoft tissueneoplasm Theradiologicmanifestationsandspectrumofsynovialsarcomareflecttheunderlyingpathologicappearance Wehavereviewed illustrated andcorrelatedtheclinical pathologic andradiologicfeaturesofsynovialsarcomaaswellasthetreatmentandprognosis Althoughtheradiographiccharacteristicsofsynovialsarcomaarenotpathognomonic thefindingsofasoft tissuemass particularlyifcalcified nearbutnotinajointinayoungpatient 15 40yearsofage areverysuggestiveofthisdiagnosis Cross sectionalimagingfeaturesarevitalforstagingextentandforplanningsurgicalresection Theyalsofrequentlyrevealsuggestiveappearancesofmultilobulationandmarkedheterogeneity creatingthetriplesign withhemorrhage fluidlevels andsepta creatingthebowlofgrapessign Twofeaturesassociatedwithsynovialsarcomathatmayleadtoaninitialmistakendiagnosisofabenignindolentprocessareslowgrowth averagetimetodiagnosis 2 4years andsmallsize 5cmatinitialpresentation inaddition theselesionsmaydemonstratewell definedmarginsandhomogeneousappearanceoncross sectionalimages Synovialsarcomaisanintermediate tohigh gradelesion and despiteinitialaggressivewidesurgicalresection localrecurrenceandmetastaticdiseasearecommonandprognosisisguarded Understandingandrecognizingthespectrumofradiologicappearancesandtheirpathologicbasesallowimprovedpatientassessmentandareimportantforoptimalclinicalmanagement Synovialsarcomawithanintermuscularoriginadjacenttothehipofan18 year oldmanwhonoticedanenlargingsoft tissuemass a b AxialT1 weighted a andT2 weighted b magneticresonance MR imagesshowalargejuxtaarticularheterogeneoussoft tissuemass M withsignalintensityslightlyhigherthanthatofmusclewithT1weightingandintermediatesignalintensitywithT2weighting Thelesioniscenteredbetweentherectus arrow tensorfascialata T andsartorius S muscles whicharedisplaced Asmallamountofintermuscularfatisseenposteriorly arrowhead c Photographoftheaxiallysectionedgrossspecimenrevealssimilarfeatureswithaseptated multilobulatedsoft tissuemass arisingbetweentherectus arrow tenorfascialata T andsartorius S muscles Synovialsarcomaoftheposteriorchestwallina31 year oldmanwithanontender progressivelyenlarging soft tissuemass a Axialpostcontrastcomputedtomographic CT scanshowsalargeposteriorchestwallmasswithlowattenuationcentrally resultingfromnecrosisandathicknodularwallperipherally arrows b Photographoftheaxiallysectionedgrossspecimenrevealssimilarfeatures withnecrosis N centrallyandathicknodularwallofviabletumor T peripherally Synovialsarcomaadjacenttotheankleina37 year oldwomanwithasoft tissuemassnotedaftertraumaanddevelopmentofhematoma a Angiogramshowsdensetumorstainingandneovascularity arrowheads ofthelargesoft tissuemassadjacenttotheankle Theposteriortibialarteryisdisplaced arrows b AxialT2 weighted 2000 80 MRimagerevealsmarkedheterogeneityandmultilobulation bowlofgrapessign withthetriplesign areasofhigh H intermediate I andlow L signalintensity fluidlevels arrowheads resultingfro