23例颞下颌关节弥漫性腱鞘巨细胞瘤的CT和MRI特征分析

doi:10.19438/j.cjoms.2019.04.017

中国口腔颌面外科杂志 ›› 2019, Vol. 17 ›› Issue (4): 359-363.doi: 10.19438/j.cjoms.2019.04.017

23例颞下颌关节弥漫性腱鞘巨细胞瘤的CT和MRI特征分析

陈培倩¹, 陶晓峰¹, 张春叶², 朱凌¹

1.上海交通大学医学院附属第九人民医院放射科;
2.口腔病理科,上海 200011

收稿日期:2019-01-30 修回日期:2019-04-23 出版日期:2019-07-20 发布日期:2019-08-12
通讯作者: 朱凌,E-mail：puxuke12@126.com
作者简介:陈培倩（1989-）,女,硕士,住院医师,E-mail：peiqian_chen@163.com

CT and MRI features of diffuse tenosynovial giant cell tumor in temporomandibular joint

CHEN Pei-qian¹, TAO Xiao-feng¹, ZHANG Chun-ye², ZHU Ling¹

1.Department of Radiology;
2.Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2019-01-30 Revised:2019-04-23 Online:2019-07-20 Published:2019-08-12

摘要/Abstract

摘要： 目的分析发生于颞下颌关节（temporomandibular joint,TMJ）区的弥漫性腱鞘巨细胞瘤（diffuse tenosynovial giant cell tumor,D-TSGCT）的临床资料和影像学表现,以提高该疾病的诊断准确性。方法回顾分析2015年11月-2018年5月上海交通大学医学院附属第九人民医院经手术病理证实的23例TMJ区D-TSGCT病例的临床病史和CT、MRI图像。结果 23例患者的临床症状主要为耳前区肿块伴肿胀、疼痛。颌面部CT示TMJ区肿块,平均CT值（72±20.49）HU,增强平均值（125.3±22.68）HU;9例（39.1%）肿块内出现不规则或类圆形相对低密度灶,增强后无强化;14例（60.1%）肿块内出现钙化灶;16例（69.6%）出现TMJ关节间隙增宽;14例（60.1%）出现髁突骨质破坏;17例（73.9%）出现关节窝骨质破坏;6例（26.1%）出现中耳鼓室壁破坏。颌面部MRI示6例（66.7%）肿块T1WI呈等低混杂信号、T2WI呈高低混杂信号;2例（22.2%）肿块T1WI、T2WI均呈低信号;1例（11.1%）肿块T1WI呈等信号,T2WI呈低信号;5例（55.6%）肿块内出现囊性变。结论 TMJ区的D-TSGCT主要临床症状为耳前区肿块伴疼痛。影像学特征为TMJ区肿块,CT平扫密度高,增强后强化明显,可有钙化,多伴有髁突、鼓室壁、关节窝骨质破坏。T2WI示肿块内特征性低信号,可出现囊性变。联合运用增强CT与MRI检查能明显提高TMJ区D-TSGCT的诊断准确性。

关键词: 弥漫性腱鞘巨细胞瘤, 颞下颌关节, CT, MRI

Abstract: PURPOSE: To analyze the clinical and imaging features of diffuse tenosynovial giant cell tumor (D-TSGCT) in temporomandibular joint (TMJ) space, in order to improve the diagnostic accuracy of the disease. Methods: Clinical features, CT and MRI findings of 23 cases confirmed by operation and pathology from November 2015 to May 2018 were analyzed retrospectively. Results: The main clinical symptoms in 23 cases were mass in preauricular region with pain. Maxillofacial CT showed mass in TMJ area,the average CT value was (72±20.49)HU,the average enhanced CT value was (125.3±22.68)HU. Nine cases (39.1%) had irregular or circular lower density lesions in the mass, but no enhancement was found after enhancement. Calcification was found in 14 cases (60.1%), widened articular space was found in 16 cases (69.6%), condylar bone destruction occurred in 14 cases (60.1%),bone destruction of articular fossa occurred in 17 cases (73.9%), tympanic destruction occurred in 6 cases(26.1%). Six cases (66.7%) showed iso-and hypo-intense signal on T1WI,hyper-and hypo-intense on T2WI; two cases(22.2%) showed hypo-intense signal on T1WI and hypo-intense on T2WI; one case（11.1%） showed iso-intense signal on T1WI and hypo-intense on T2WI. Cystic lesions were found in 5 cases (55.6%). Conclusions: The main clinical symptoms of D-TSGCT in TMJ space is mass in preauricular region with pain. Imaging features are high density of masses with calcifications, enhancement obviously after contrast injection and destruction of condyle, articular fossa and tympanic walls. T2WI shows characteristic low signal, cystic lesions may occur. Combined use of enhanced CT and MRI can significantly improve the diagnostic accuracy of D-TSGCT in TMJ.

Key words: Diffuse tenosynovial giant cell tumor, Temporomandibular joint, CT, MRI

中图分类号:

R739.8

陈培倩, 陶晓峰, 张春叶, 朱凌. 23例颞下颌关节弥漫性腱鞘巨细胞瘤的CT和MRI特征分析[J]. 中国口腔颌面外科杂志, 2019, 17(4): 359-363.

CHEN Pei-qian, TAO Xiao-feng, ZHANG Chun-ye, ZHU Ling. CT and MRI features of diffuse tenosynovial giant cell tumor in temporomandibular joint[J]. China J Oral Maxillofac Surg, 2019, 17(4): 359-363.

参考文献

[1] 郭坚, 文国英, 张根娣, 等. 局限性和弥漫性腱鞘巨细胞瘤52例临床及病理[J]. 诊断病理学杂志, 2001, 8(5): 272-274.
[2] Lucas DR.Tenosynovial giant cell tumor: case report and review[J]. Arch Pathol Lab Med, 2012, 136(8): 901-906.
[3] Aurégan JC, Klouche S, Bohu Y, et al.Treatment of pigmented villonodular synovitis of the knee[J]. Arthroscopy, 2014, 30(10): 1327-1341.
[4] Ding Y, Griffin JE, Raghavan M, et al.Tenosynovial giant cell tumors lacking giant cells: report of diagnostic pitfalls[J]. Ann Clin Lab Sci, 2014, 44(2): 222-227.
[5] Boland JM, Folpe AL, Hornick JL, et al.Clusterin is expressed in normal synoviocytes and in tenosynovial giant cell tumors of localized and diffuse types: diagnostic and histogenetic implications[J]. Am J Surg Pathol, 2009, 33(8): 1225-1229.
[6] West RB, Rubin BP, Miller MA, et al.A landscape effect in tenosynovial giant-cell tumor from activation of CSF1 expression by a translocation in a minority of tumor cells[J]. Proc Natl Acad Sci USA, 2006, 103(3): 690-695.
[7] Gouin F, Noailles T.Localized and diffuse forms of tenosynovial giant cell tumor (formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis)[J]. Orthop Traumatol Surg Res, 2017, 103(1S): S91-S97.
[8] 孟娟红, 郭玉兴, 罗海燕, 等. 颞下颌关节弥漫型腱鞘巨细胞瘤的诊断与治疗[J]. 北京大学学报(医学版), 2016, 48(6): 1049-1054.
[9] 王韶颖, 石慧敏, 王平仲, 等. 颞下颌关节弥漫型巨细胞瘤的CT表现[J]. 中国口腔颌面外科杂志, 2012, 10(3): 236-240.
[10] Le WJ, Li MH, Yu Q, et al.Pigmented villonodular synovitis of the temporomandibular joint: CT imaging findings[J]. Clin Imaging, 2014, 38(1): 6-10.
[11] Taylor R, Kashima TG, Knowles H, et al.Osteoclast formation and function in pigmented villonodular synovitis[J]. J Pathol, 2011, 225(1): 151-156.
[12] Kim KW, Han MH, Park SW, et al.Pigmented villonodular synovitis of the temporomandibular joint: MR findings in four cases[J]. Eur J Radiol, 2004, 49(3): 229-234.
[13] Somerhausen NS, Fletcher CD.Diffuse-type giant cell tumor: clinicopathologic and immunohistochemical analysis of 50 cases with extraarticular disease[J]. Am J Surg Pathol, 2000, 24(4): 479-492.
[14] Nackos JS, Wiggins RH, Harnsberger HR.CT and MR imaging of giant cell granuloma of the craniofacial bones[J]. AJNR Am J Neuroradiol, 2006, 27(8): 1651-1653.
[15] 余强. 颌面颈部肿瘤影像诊断学 [M]. 上海: 世界图书出版公司, 2009.
[16] Lim SW, Jeon SJ, Choi SS, et al.Synovial chondromatosis in the temporomandibular joint: a case with typical imaging features and pathological findings[J]. Br J Radiol, 2011, 84(1007): e215-e218.
[17] 韩孜祥, 陈敏洁, 杨驰, 等. 171例颞下颌关节滑膜软骨瘤病MRI分析[J]. 中国口腔颌面外科杂志, 2017, 15(1): 41-45.
[18] Giorgione C, Passali FM, Varakliotis T, et al.Temporo-mandibular joint chondrosarcoma:Case report and review of the literature[J]. Acta Otorhinolaryngol Ital, 2015, 35(3): 208-211.

23例颞下颌关节弥漫性腱鞘巨细胞瘤的CT和MRI特征分析

CT and MRI features of diffuse tenosynovial giant cell tumor in temporomandibular joint

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