O'Driscoll Dearbhail, Athanasian Edward, Hameed Meera, Hwang Sinchun
Memorial Sloan Kettering Cancer Center, New York, NY, USA,
Skeletal Radiol. 2015 May;44(5):641-8. doi: 10.1007/s00256-014-2078-0. Epub 2014 Dec 21.
To determine the imaging features of hemosiderotic fibrolipomatous tumor (HFLT), which has a propensity towards local recurrence and the potential to transform into myxoinflammatory fibroblastic sarcoma (MIFS).
The study included 8 patients with a diagnosis of HFLT and imaging at a tertiary cancer center. Imaging studies included radiographs (n = 2), ultrasound (n = 3), and MRI (n = 16). Imaging features were evaluated including location, calcification, sonographic echogenicity, vascular flow, size, border, signal characteristics, contrast enhancement, and blooming on MRI.
The HFLT was located in the ankle/foot in 4 out of 8 and was subcutaneous in 8 out of 8, ranging in size from 2 to 18 cm. Histology at initial diagnosis was HFLT in 5 out of 8 and HFLT with MIFS in 3 out of 8. None was calcified on radiography. On ultrasound 2 out of 3 were heterogeneously echogenic with ≥10 foci of vascular flow. Two out of 8 patients had MRI only at local recurrence. The tumor border was infiltrative in 4 out of 6 at initial diagnosis and in 2 patients with MRI at recurrence only. Fat and septae were present in 7 out of 8 at initial diagnosis and at recurrence. Signal intensity was iso-/hypointense to muscle on T1-weighted sequences in more than two thirds of the tumor in 4 out of 7 and hyperintense to muscle in at least one third of the tumor on fluid-sensitive sequences in 6 out of 8. Contrast enhancement was heterogeneous in 7 out of 7; blooming in two thirds of the tumor on gradient-echo sequence MRI indicated hemorrhage.
The HFLT commonly presents as a mass with an infiltrative border, interspersed fat and septations at initial diagnosis and local recurrence on MRI regardless of histology of HFLT alone or with MIFS. Hemosiderin deposits may be detected as blooming on gradient-echo sequences.
确定含铁血黄素性纤维脂肪瘤（HFLT）的影像学特征，该肿瘤易于局部复发且有转化为黏液炎性纤维母细胞肉瘤（MIFS）的可能。
本研究纳入了8例在三级癌症中心诊断为HFLT并接受影像学检查的患者。影像学检查包括X线片（n = 2）、超声（n = 3）和磁共振成像（MRI，n = 16）。评估的影像学特征包括位置、钙化、超声回声性、血流、大小、边界、信号特征、对比增强以及MRI上的磁敏感伪影。
8例中有4例HFLT位于踝/足部，8例均位于皮下，大小范围为2至18 cm。初始诊断时8例中有5例组织学为HFLT，8例中有3例为伴有MIFS的HFLT。X线片上均无钙化。超声检查3例中有2例回声不均匀，有≥10个血流灶。8例患者中有2例仅在局部复发时进行了MRI检查。初始诊断时6例中有4例肿瘤边界呈浸润性，仅2例复发时行MRI检查的患者肿瘤边界呈浸润性。初始诊断及复发时8例中有7例存在脂肪和间隔。7例中有4例超过三分之二的肿瘤在T1加权序列上信号强度与肌肉等/低信号，8例中有6例至少三分之一的肿瘤在液体敏感序列上信号强度高于肌肉。7例中有7例对比增强不均匀；梯度回波序列MRI上三分之二的肿瘤出现磁敏感伪影提示出血。
无论组织学为单纯HFLT还是伴有MIFS，HFLT在初始诊断及局部复发时在MRI上通常表现为边界浸润的肿块，内有散在脂肪和间隔。含铁血黄素沉积在梯度回波序列上可表现为磁敏感伪影。
