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目的 探讨Merkel细胞瘤的影像学诊断方法。方法 对一例女性 ,44岁。通过CT、MRI、病理、手术观察其影像及病理特征。结果 病理见 :红褐色肿物 ,呈烂肉样 ,质中 ,易于吸除 ,血运丰富。枕骨破坏 ,枕部肌肉、硬膜表面及小脑内均有肿瘤侵润 ,与脑组织无明显界限。光镜 :肿瘤位于真皮 ,有时在皮下。癌细胞聚集分布 ,细胞大小一致 ,类圆形 ,似小淋巴细胞 ;细胞核呈空泡状 ,可见许多核分裂像 ,染色质呈细颗粒状 ;胞浆稀少 ,嗜酸染色。免疫组化 :NSE (神经内分泌颗粒 ) :阳性。角蛋白 :阳性。CT见略高密度均匀的病变 ,MRI上T1w、T2w呈略低信号 ,边界不清 ;MRI可见病变异常强化 ,边界清晰 ;局部软组织侵润及骨破坏。结论 CT和MRI可以清楚显示病变部位特点 ,为临床提供可靠信息 ,利于手术。
Objective To investigate the imaging diagnosis of Merkel’s tumor. Method to a female, 44 years old. Through CT, MRI, pathology, surgery to observe the image and pathological features. Results Pathology see: reddish-brown mass, was rotten meat-like, quality, easy to suck, rich blood supply. Occipital bone destruction, occipital muscles, dura surface and cerebellum have tumor infiltration, and brain tissue no obvious boundaries. Light microscopy: The tumor is located in the dermis, sometimes subcutaneously. The distribution of cancer cells, the same cell size, round, small lymphocytes; nucleus was vacuolar, showing a number of mitotic figures, fine chromatin; cytoplasmic sparse, eosinophilic staining. Immunohistochemistry: NSE (neuroendocrine granules): positive. Keratin: Positive. CT see a slightly high-density lesions, MRI, T1w, T2w showed a slightly lower signal, the border is not clear; MRI showed abnormal enhancement, clear boundary; local soft tissue invasion and bone destruction. Conclusion CT and MRI can clearly show the characteristics of the lesion, provide reliable information for clinical operation, and benefit the operation.