双语病例丨原发性骨平滑肌肉瘤（XMRPET）

双语病例丨原发性骨平滑肌肉瘤（XMRPET）

History: A 43-year-old woman presents with knee pain after feeling a popping sensation while playing tennis.

病史：43岁女性，打网球时感觉到砰的感觉，膝部疼痛。

Radiographs were obtained. 平片如下所示。

问答：

There is a lesion in the proximal tibia with a benign appearance.

•True

•False (correct!)

胫骨近端病灶呈良性表现。答：错误。

The lesion in the proximal tibia has aggressive features, including an infiltrative appearance and ill-defined margins.

胫骨近端病灶有侵袭性，呈浸润性表现，边界模糊。

MR images

An MRI scan of the knee was performed. Intravenous contrast was not administered due to acute kidney injury. Coronal T1-weighted nonfat-saturated and T2-weighted fat-saturated images are shown below.

行膝关节MR扫描。由于急性肾损伤未行增强扫描。冠状T1WI非压脂及T2WI压脂图像如下所示。

问答

What is the next step? 下一步该做什么？

•Short-term imaging follow-up 短期随访

•No additional follow-up required 无需随访

•Biopsy (correct!) 活检（正确答案）

Additional questions

Biopsy of the tibial lesion revealed a pathologic diagnosis of leiomyosarcoma.

胫骨病变活检，病理诊断为：平滑肌肉瘤。

Primary bone leiomyosarcomas are common primary bone malignancies.

•True

•False (correct!)

原发性骨平滑肌肉瘤是常见的原发性骨恶性肿瘤。（说法错误）

Which of the following is more likely? 下列那种情况最可能？

•Primary bone leiomyosarcoma 原发性骨平滑肌肉瘤

•Leiomyosarcoma metastasis to bone (correct!) 平滑肌肉瘤转移至骨骼（正确）

Pelvic MR images

An MRI scan of the pelvis was performed. Sagittal and axial T2-weighted images are shown.

盆腔MR图像：行盆腔MR扫描，矢状及轴位T2WI图像如下所示。

The uterine findings are highly suspicious for uterine leiomyosarcoma.

•True

•False (correct!)

子宫的表现应高度怀疑为子宫平滑肌肉瘤（说法错误）。

There are typical findings of small benign leiomyomas. However, small leiomyosarcomas can have the same appearance as benign leiomyomas.

为小良性平滑肌瘤的典型表现，然而，小的平滑肌肉瘤可能与良性平滑肌瘤有着同样的表现。

PET/CT images

A whole-body FDG-PET/CT scan was performed. Fused CT/PET images are shown (axial pelvis and coronal knees).

行全身PET/CT，CT/PET融合图像如下所示（盆腔轴位、膝部冠状）

The right proximal tibial lesion shows avid FDG uptake.

•True (correct!)

•False

右胫骨近端病灶可见明显FDG摄取（说法正确）。

The uterus shows a lesion with avid FDG uptake.

•True

•False (correct!)

子宫病灶可见明显FDG摄取（说法错误）。

Additional questions

Because uterine leiomyosarcomas are much more common than primary bone leiomyosarcomas, the patient underwent a hysterectomy to evaluate for a primary uterine leiomyosarcoma.

On pathologic evaluation, the uterus had only benign findings.

其他问题

由于子宫平滑肌肉瘤比原发性骨平滑肌肉瘤更常见，患者接受了子宫切除术以评估是否为原发性子宫平滑肌肉瘤。最后病理诊断只有良性发现，为子宫平滑肌瘤。

Primary bone leiomyosarcomas have a distinct histologic appearance to leiomyosarcomas arising from other sites.

•True

•False (correct!)

原发性骨平滑肌肉瘤与其他部位的平滑肌肉瘤有不同的组织学表现（说法错误）。

Primary bone leiomyosarcomas most commonly occur in the spine.

•True

•False (correct!)

They most commonly occur in the appendicular skeleton.

原发性骨平滑肌肉瘤最常见于脊柱（说法错误），最常见于四肢骨。

Primary bone leiomyosarcomas have a distinct radiologic appearance when compared with other primary bone sarcomas.

•True

•False (correct!)

与其他原发骨肉瘤相比，原发性骨平滑肌肉瘤有着不同的影像学表现（说法错误）。

Findings