目的:探讨血肿样高度恶性肉瘤(hematoma鄄likehigh鄄gradesarcoma,HLHGS)的临床病理特点及预后。方法:分析15例HLHGS患者的临床、磁共振成像(MRI)和病理资料。标本经10%中性甲醛固定,石蜡包埋,苏木精鄄伊红染色和免疫组织化学ABC标记。结果:15例HLHGS临床均诊断为“血肿”。肿瘤位于大腿6例,小腿2例,上臂2例,踝部、腋窝、前臂、腹股沟和臀部各1例。MRI检查示:①病变长径与短径比为2∶1;②对比增强时显示“血肿壁”上肿瘤结节;③T1水平病变中间带强度同骨骼肌,T2水平中度增强,但强度低于液体。病理检查示病变中出血成分>85%,肿瘤组织学类型为恶性纤维组织细胞瘤7例,平滑肌肉瘤4例,滑膜肉瘤、恶性周围神经鞘膜瘤、横纹肌肉瘤和软组织黏液性软骨肉瘤各1例。按美国癌症联合会肿瘤分期Ⅲb12例,Ⅳb3例。术后随访6～60个月,其中无瘤生存6例,带瘤生存5例,死于肿瘤4例。复发率为13.3%,转移率为53.3%,2年生存率为73.3%。结论:血肿样肉瘤是高度侵袭性的软组织肉瘤,但其临床表现、超声波检查和CT扫描及细针抽吸活检易误诊为良性血肿。MRI检查可显示肿瘤性结节。CT引导下穿刺能明确诊断。 Objective: To investigate the clinicopathological features and prognosis of hematoma-like high-gradesarcoma (HLHGS). Methods: Clinical, magnetic resonance imaging (MRI) and pathological data of 15 patients with HLHGS were analyzed. Specimens were fixed with 10% neutral formaldehyde, embedded in paraffin, stained with hematoxylin and eosin, and labeled with immunohistochemistry ABC. Results: 15 cases of HLHGS clinically diagnosed as “hematoma.” The tumors were located in 6 cases of thigh, 2 cases of lower leg, 2 cases of upper arm, 1 case of ankle, armpit, forearm, groin and buttock. The MRI examination showed: ① The ratio of the major axis to the minor axis of the lesion was 2:1; ② The tumor nodules on the “hematoma wall” showed contrast enhancement; ③ The intermediate zone intensity of T1 level was the same as that of skeletal muscle, while the level of T2 was moderately enhanced; In liquid. Pathological examination showed bleeding lesions component> 85%, histological type of malignant fibrous histiocytoma 7 cases, 4 cases leiomyosarcoma, synovial sarcoma, malignant peripheral nerve sheath tumors, rhabdomyosarcoma soft tissue and mucous chondrosarcoma 1 each example. According to the American Cancer Society staging Ⅲ b12 cases, Ⅳ b3 cases. The patients were followed up for 6 to 60 months, of which 6 patients survived without tumor, 5 patients with tumor and 4 patients died of tumor. The recurrence rate was 13.3%, the metastasis rate was 53.3%, and the 2-year survival rate was 73.3%. Conclusion: Hematoma-like sarcoma is a highly invasive soft tissue sarcoma, but its clinical manifestations, ultrasonic examination, CT scan and fine needle aspiration biopsy are often misdiagnosed as benign hematoma. MRI examination can show tumor nodules. CT-guided puncture can confirm the diagnosis.