王亚文，王丽君

作者单位：1.大连医科大学，大连116044；2.大连医科大学附属第一医院，大连116011

图1 患者男，17 岁。A、B：MRI 示左侧颈项部不规则肌肉间占位，呈类似椭圆形。肿块实性部分呈T1WI 稍高信号(A，箭)、T2WI高信号(B，箭)，信号基本均匀，其内可见少许条状T1WI低、T2WI明显高信号(箭头)。C：DWI肿瘤呈明显高信号；D：ADC图肿瘤信号未见明显降低；动态增强扫描动脉期(E)及延迟期(F)：病灶实性部分明显强化，瘤内分隔呈延迟强化；G：病理示短梭形肿瘤细胞紧密排列(HE ×400)；H：免疫组化：vimentin(+)Fig.1 A 17-year-old male patient.A, B: MRI shows an irregular mass between the muscles of the left posterior neck. It is almost like an oval.The solid part appears as slightly hyperintensity on T1WI (A,arrow) and hyperintensity on T2WI (B,arrow).The most part of the mass is homogeneous with a few strip-like foci with hypointensity on T1WI and significant hyperintensity on T2WI (arrow head). C: It is strongly high signal intensity on DWI. D: The reduction of ADC is not obvious. E, F: The solid part of the lesion is strongly enhanced on contrast-enhanced T1WI, and the separation is enhanced gradually. G: Short spindle-shaped tumor cells were arranged densely on HE staining(HE ×400).H:Immunohistochemistry:vimetin(+).

患者男，17岁。因左颈项部肿物进行性增大4个月入院。4个月前体检发现左颈项部鸡蛋大小肿物，超声检查诊断实性占位，未行特殊治疗，近4 个月来肿物进行性增大。患者病来肿块无疼痛及压痛，皮肤无破溃及红肿，双上肢无疼痛麻木，无头痛头晕，无胸痛胸闷，其他无特殊。体检：左侧颈项部肿物，边界清晰，活动差，未触及肿大淋巴结。颈部MRI显示：左侧后颈部肌肉间肿物(图1A～G)。术中显示肿物位于肌间隙内，未见明确包膜，类圆形，与周围组织粘连，肿瘤质软、脆，血运丰富，鱼肉状，内可见出血及坏死组织。病理检查：肿物灰粉色，水肿状外观，质脆。镜下大量梭形细胞、嗜脂细胞及毛细血管，肿瘤细胞紧密排列，大小相对一致，核分裂可见。免疫组化：ACTIN (－)，Bcl-2 (+)，CD99 (+)，CK19 (NS)，EMA (灶 状)，HMB45 (－)，S-100 (－)，Vimentin (+)，keractin (－)。病理支持滑膜肉瘤(图1G、H)。随访5年，患者局部无复发。

讨论滑膜肉瘤是一种恶性间充质肿瘤，来源于结缔组织而非滑膜[1]。全身各部位均可发病，多见于四肢，原发于颈部的滑膜肉瘤罕见[2]。患者以青年居多[1,3-4]，临床症状主要取决于肿瘤所在位置及大小[4]，本例患者发病年龄与文献报道相符，临床表现不典型。……