摘要
目的 探讨泌尿生殖系统孤立性纤维瘤(SFT)的诊断、治疗、长期随访结果,并比较良恶性SFT的特点.方法 回顾性分析南京鼓楼医院2004年1月—2021年8月收治的20例泌尿生殖系统SFT患者,分析患者的一般特征、临床症状、影像学结果、治疗方法、病理及长期随访结果等资料.结果 患者肿瘤发生在肾脏9例、盆腔7例、膀胱3例、前列腺1例.6例表现出临床症状,包括下肢无力、尿痛、排尿困难、尿频伴排便习惯改变、腰痛、腹壁包块伴腹痛等,14例无任何症状.肿瘤中位直径5.2(1.7～15.0)cm.所有患者均行手术治疗,其中机器人辅助下手术8例、开放手术5例、腹腔镜下手术5例、经尿道切除膀胱肿瘤2例.CT平扫表现为高、低、混合密度软组织肿块均可存在,强化CT出现强化结果.病理显示恶性SFT组织的核分裂象、形态变异、坏死、Ki-67指数高表达比例明显高于良性SFT.改良的Demicco预后风险分层模型结果显示,所有恶性SFT患者均为中等风险.SFT根治性肿瘤切除术组无病生存期(DFS)比单纯肿瘤切除术组稍长,但差异无统计学意义(P=0.203).结论CD34、Bcl2、STAT6、CD99等标志物可用于诊断SFT;Ki-67指数、肿瘤坏死常用于鉴别其良恶性;改良的Demicco预后风险分层模型在预测SFT的预后中具有重要作用;手术切除是SFT最常见的治疗方法,良性SFT预后优于恶性.
Abstract
Objective To explore the diagnosis,treatment,prognosis and long-term follow-up of urogenital solitary fibrous tumor(SFT)and to differentiate the characteristics between benign and malignant SFT.Methods Clinical data of 20 patients with urogenital SFT treated in our hospital during Jan.2004 and Aug.2021 were respectively analyzed,including the general characteristics,clinical symptoms,imaging results,treatment methods,pathological results,and long-term follow-up results.Results Of the 20 cases,9 cases had tumor in kidney,7 in pelvic cavity,3 in bladder and 1 in prostate.Six patients showed non-specific clinical symptoms,including lower extremity weakness,urodynia,dysuria,frequent urination with changes in stool habits,low back pain,and abdominal wall mass with abdominal pain,and the other 14 cases were asymptomatic.The median diameter of SFT was 5.2 cm(range:1.7-15.0 cm).All patients received surgical treatment,including robotic-assisted surgery in 8 cases,open surgery in 5 cases,laparoscopic surgery in 5 cases,and transurethral resection of tumor in 2 cases.CT plain scan showed high,low and mixed density soft tissue masses,and enhanced CT showed enhanced results.Pathology results revealed frequent nuclear divisions,morphological variations and necrosis in malignant SFT,which had higher expression of Ki-67 than benign SFT.The results of the modified Demicco prognostic risk stratification model showed that all malignant SFT cases were at intermediate risk.The DFS of the SFT radical tumor resection group was slightly longer than that of the simple tumor resection group but the difference was not statistically significant(P=0.203).Conclusion Markers such as CD34,Bcl2,STAT6 and CD99 are used to diagnose SFT,while Ki-67 and tumor necrosis are used to differentiate benign and malignant SFT.The modified Demicco prognostic risk stratification model plays an important role in predicting the prognosis of SFT.Surgical resection is the most common treatment with excellent prognosis.In addition,benign SFT has much better prognosis than malignant case.
维普
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