Three magnetic resonance imaging performance of adenosine soft tissue sarcoma

Adenospora soft tissue sarcoma (ASPS) is a rare soft tissue malignant tumor that accounts for less than 1% of soft tissue sarcomaThe disease is common in young and middle-aged women aged 15 to 35 years old, the most commonly affected areas are deep soft tissue in the lower extremities, especially the thighs, a few cases can be located in the female reproductive tract, breast, shoulder blades, drum chamber, nasal cavity and other partsNow organize the 2009-2012 hospital by histopathology confirmed adenosphation soft tissue sarcoma 3 cases, analysis of its clinical data, magnetic resonance imaging (MRI) signal characteristics and pathological histology performance, and related literature review1Data and methods1.1 Clinical data: 3 cases of adenosine-like soft tissue sarcoma confirmed by surgical pathology, 1 case of male, 2 cases of female, age 22-31 years old, median age 27 years old3 cases occurred in the buttocks, femtoidal and abdominal wallsThe course of 1 to 3 years, the clinical manifestations of the increased soft tissue lumps, only 1 case accompanied by local mild painIn all 3 patients, MRI was flushed and enhanced1.2 imaging methods: MRI examination using Philips 1.5T superconducting magnetic resonance instrument, 3 patients using TSE-T1WI, TSE-T2WI and short-term reverse recovery sequence (STIR) for conventional axial, gyade and coronary scanning; The scanning layer is 5mm thick, the spacing is 5.50mm, and the matrix is 320 x 241Results3 cases of tumors were found in the buttocks, femur and abdominal wall, are single hair, larger, size 4.9 cm x 7.6 cm to 7.0 cm x 9.7 cm, 3 cases of tumor boundary is unclear, 3 cases are seen shallow leaves, 2 cases of tumor The body can be seen strip separation, 1 case of tumor around an incomplete envelope, 3 cases of tumor signal is not uniform, compared with adjacent muscles, the tumor is medium T1 long T2 signal (Figure 1,2a), the internal size is significantly long T1 long T2 necrosis cystic lesionsThe real part of the enhanced scanning lump was significantly strengthened, and the necrotic cyst area was not strengthenedIn 3 cases, the edges and surroundings of the lump were seen with a large number of typical "vascular fluid" shadows (Figure 2b), and significant vascular shadows were seen on the maximum density projection reconstruction (MIP) (Figure 3)Figure 1 T2WI regular sequence uneven high signal, within the necrosis cystic region; Figure 2 Vascular flow air shadow (a: T2WI lump internal vascular vasoilan hollow shadow; b: enhanced when the lump is seen vascular air shadow); Figure 3 T2WI lipid sequence and enhancement, MIP (a: T2 coronal ununiform high signal; b: T1WI The block sees the reinforced cerebral hemorrhagic hemorrhagic shadow; c: MIP sees obvious vascular manifestations)postoperative histology is shown as follows: low-fold mirror, the tumor is composed of a tumor cell nest arranged into "organ-like" or "adenosion-like", between the cell nests for a wide narrow range of fibrous intervals, adenostosis between the lining of single layer of flat endothelial cells or hematosons 3 cases all appeared sinus-like vascular cavity, cell larger, cytoplasm rich, 1 case of different type is not obvious, 2 cases of the shape is obvious (Figure 4, 5) Figure 4 Under a low-fold mirror, the tumor consists of a tumor cell nest arranged as "organ-like" or "adenossion-like" with wide and narrow fibrous intervals (HE staining x 100
); 3 Discussion ASPS growth is slow, there are literature reported disease course up to decades, this group of cases medical history of 1 to 3 years, but the probability of ASPS transfer is relatively large, there are literature reported that about 20% to 25% of the confirmed patients found metastatic lesions, and lung or brain transfer as the first performer ASPS metastasis is mostly blood line transfer, the lungs is the most common metastasis, visible in 42% to 65% of patients, while lymph node metastasis only occurred in 10% of patients, 1 case of this group of cases had diffuse pulmonary metastasis, no lymph node metastasis at present, the World Health Organization (WHO) classified ASPS as undetermined differentiated tumors, its general pathology is shown to be that the tumor has an incomplete envelope, cut gray or gray-brown, solid, fish-like, tumor-like, tumor can occur when the tumor is large Histopathologicalism is characterized by loose tumor cells, rehearsed into a substantial adenossion-like or nest-like structure, lined with single layers of endothelial cells, surrounded by thin-walled sinus-like blood vessels Tumor cells are polygonal, including one or more bubble nuclei, nuclear kernels significantly increased, cytoplasm rich, visible in the erythema red staining fine granules, cell nest in the center of the can appear degeneration or necrosis The characteristic nest or adenosine structure and sinus-like blood vessels were visible in the mirror of this group of cases, consistent with the literature ASPS MR signal characteristics of T1WI or other high signal, T2WI high signal, characterized by the inside or edge of the lump to see multiple heagiovadotic air shadow, and the hetology of vascular air is the tumor cell nest around the thin-walled sinus-like blood vessels Due to the influence of blood flow velocity in the blood vessels led to different signal changes in T1WI and T2WI, coupled with the lesions prone to bleeding, necrosis, resulting in some cases of vascular emptying effect is not typical, at this time high field strong magnetic resonance imaging (MRA) or digital angiography (DSA) for ASPS aneurysms and drainage veins display has a relatively good specificity in this study, the tumor is equal or slightly shorter T1WI, long T2WI signal, the lesions edge and surrounding are seen vascular air signal shadow, of which 1 case of lesions see a large number of vascular air signal shadow, enhanced significantly strengthened, central necrosis zone is not strengthened, these manifestations are consistent with previous literature reports, but also with pathological histology has a good consistency The identification diagnosis of ASPS mainly includes adenosphinic transverse mucosal tumors, malignant fibroblastoma, fibroids, sliding sarcoma and venous malformations Adenossie-like horizontal, considered to be good in the adolescent limbs deep soft tissue, is a primitive, cell-like lymphoma-like circular cell tumor, and has partial skeletal muscle differentiation characteristics, is a high degree of malignant histological type in cross-sectional muscle tumor, adults are less common, prognosis MRI showed medium T1, long or mixed T2 signals, and there was a common necrosis in the tumor, which was strengthened significantly However, imaging is difficult to identify with adenosine soft tissue sarcoma, diagnosis requires pathological examination Malignant fibroblasts occur at most after limbs, torso and peritoneals, for the origin of the potential differentiation of fibroblasts and tissue cell tendency of undifferentiated interstitated leaf cells, mostly occurred in 30 to 70 years old, T1WI is a medium signal, T2WI is uneven high signal, T2WI saw irregular low signal, Yang Xingfeng and other confirmed that it is collogen fiber, which can be used as a point of identification the incidence of fibroids is very low, in the oral jaw facial sarcoma is more common, any age can be sick, to the middle-aged population more than common, imaging performance is diverse, easy to invade near the bone Slip-membrane sarcoma is the fourth common soft tissue sarcoma, belonging to the differentiation of uncertain tumors, can occur in any part of the human body, due to the complex composition of sliding sarcoma, the common small lesions within the characteristics of small stove calcification stove, enhanced scanning when the actual composition of the tumor strengthened, necrosis, cysts, hematoma and fibrous separation is not strengthened, many are significantly uneven lynable Although the characteristic blood supply arteries and drainage veins of the active veins are similar to the disease, it is not difficult to identify them because they do not form lumps themselves , although adenosine soft tissue sarcoma is rare, its more characteristic clinical and MRI performance is still of great help to the correct diagnosis of the disease Therefore, in the clinical, young and middle-aged female patients with slow growth occurred in muscle tissue, especially the tumor of lower limb muscles, its MRI performance of T1WI or slightly higher signal, T2WI high signal, the lesions inside or around the inside and surrounding with more distorted vascular air signal, should think of the possibility of this disease