■滑膜肉瘤是间质起源的恶性肿瘤,恶性程度高,易转移。多见于四肢远端或邻近关节,最常见于深膝关节。原发性骶骨滑膜肉瘤(PSSS)极为罕见。报告1例单相PSSS的PET/CT影像学表现。临床,成像,和病理数据进行了总结,并对文献进行了综述。
■一名67岁女性患者于2022年9月16日出现骶尾部疼痛,无明显原因,夜间偶尔疼痛,以及髋关节屈曲和长距离行走时疼痛加剧,休息可以稍微缓解,没有特殊待遇。在1个月前到江西省人民医院进一步治疗,入院后,实验室检查呈阴性。CT平扫示S1-3椎体扩张性骨破坏,软组织密度约58mm×46mm×52mm。边界是明确的,椎骨内可见坏死,肿块与骶前血管和直肠之间的边界不清楚。非对比MRI扫描显示腰骶肿块有混合信号,T1中的信号相等,T2中的信号不均匀且稍高。可见囊性变性和坏死,腰骶部肿块有多个隔室。MRI增强显示腰骶部肿块增强不均匀,多室,未见增强囊性病变。左侧骶骨翼骨被破坏,如大的片状不均匀加固所示。PET/CT显示S1-3椎体和左侧骶骨翼骨破坏,形成软组织阴影,侵入骶管和S1-3的左孔。FDG代谢显著增加,PET/CT诊断为恶性肿瘤。病理检查:病理诊断为单相PSSS。全身化疗和局部放疗后,到目前为止,CT上没有发现明显的复发和转移迹象。继续进行后续治疗。
■PSSS的发生率非常低,临床及影像学表现缺乏特征性,最后的诊断还需要病理学.PET/CT显像对PSSS的诊断具有必定的价值,在术前分期、术后疗效评价,和后续行动。
UNASSIGNED: Synovial sarcoma is a malignant tumor of mesenchymal origin with a high degree of malignancy and easy metastasis. It mostly occurs in distal extremities or adjacent joints, and it is most common in deep knee joint. Primary sacral synovial sarcoma (PSSS) is extremely rare. The PET/CT imaging findings of a case of
monophasic PSSS were reported. The clinical, imaging, and pathological data were summarized, and the literature was reviewed.
UNASSIGNED: A 67-year-old female patient presented with sacrococcygeal pain without obvious causes on 16 September 2022, with occasional pain at night, as well as aggravated pain during hip flexion and long-distance walking, which could be slightly relieved with rest, without special treatment. For further treatment before 1 month to Jiangxi Provincial People\'s Hospital, after admission, laboratory tests were negative. Non-contrast CT scan showed expansive bone destruction in the S1-3 vertebrae with soft tissue density of about 58 mm × 46 mm × 52 mm. The boundary was clear, necrosis was visible within the vertebrae, and the boundary between the mass and the anterior sacral blood vessels and rectum was unclear. Non-contrast MRI scan showed mixed signals in lumbosacral masses, with equal signals in T1 and uneven and slightly higher signals in T2. Cystic degeneration and necrosis were visible, with multiple compartments in the lumbosacral masses. MRI enhancement showed uneven enhancement of lumbosacral mass with multiple compartments and no enhanced cystic lesion. The left sacral alar bone is destroyed, as shown by large flaky uneven strengthening. PET/CT showed that S1-3 vertebral body and left sacral alar bone were destroyed and soft tissue shadow formed, invading the sacral canal and the left foramina of S1-3. FDG metabolism was significantly increased, and malignant tumor was diagnosed by PET/CT. Pathological examination: The pathological diagnosis was
monophasic PSSS. After systemic chemotherapy and local radiotherapy, no significant signs of recurrence and metastasis were found on CT so far. Follow-up treatment was continued.
UNASSIGNED: The incidence of PSSS is very low, its clinical and imaging manifestations lack characteristics, and the final diagnosis still needs pathology. PET/CT imaging has a certain value in the diagnosis of PSSS and has great application value in the preoperative staging, postoperative efficacy evaluation, and follow-up.