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老年女性，进行性消瘦半年伴发烧、乏力8天，请诊断！

2020-06-04 影像园 影像园

脾脏血管内皮肉瘤
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老年女性，进行性消瘦半年伴发烧、乏力8天，请诊断！

【所属科室】

肿瘤科

【基本资料】

患者，女，69岁

【主诉】

进行性消瘦半年伴发烧、乏力8天

【其他检查】

WBC：19x10∧9/L，肝功ALP：232U/L，B超：肝脾多发实性占位

【影像图片】

【讨论问题】如何诊断？

【讨论】

评论：脾脏明显不规则增大，脾内密度不均，可见多发大小不等低密度灶，境界不清，病灶内可见散在钙化。增强扫描呈不规则明显强化，静脉期强化持续。肝脏内可见多发散在类圆形低密度灶，脾病灶明显重于肝脏。脾脏血管肉瘤并肝脏转移可能。

【结果】

病理诊断：脾脏血管内皮肉瘤

【病例小结】

原发性脾血管内皮肉瘤是起源于脾窦内皮细胞的恶性肿瘤，发病率为0.14～0.25/100万，在脾脏原发性恶性肿瘤中占第2位。发病年龄在19～86岁，平均年龄52岁， 男性略多于女性,女之比为4:3。临床表现为脾脏迅速增大伴左上腹痛，贫血、肝肿大及体重减轻；短期内即发生转移，70%的病人发生肝脏转移；1/3的病人发生并发脾破裂。本病恶性程度高，病程进展迅速，预后差，其半年生存率仅为20%。【CT表现】1.脾脏明显肿大，密度不均，可见单发或多发低密度灶，可有钙化。2.增强扫描脾脏病灶呈不均匀轻中度强化，可有囊变坏死，也可有自病灶边缘向中心扩展式强化。3.肝、肺、骨、脑等转移的相关CT表现。

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评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1742044, encodeId=08291e4204439, content=<a href='/topic/show?id=6e29658163e' target=_blank style='color:#2F92EE;'>#消瘦#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65816, encryptionId=6e29658163e, topicName=消瘦)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6ab635012667, createdName=fengyqf, createdTime=Sun Jun 07 05:30:34 CST 2020, time=2020-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976638, encodeId=4cb619e6638cc, content=<a href='/topic/show?id=acd4943925f' target=_blank style='color:#2F92EE;'>#进行性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94392, encryptionId=acd4943925f, topicName=进行性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=869698, createdName=ligang4439, createdTime=Mon Aug 24 15:30:34 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1369132, encodeId=6d87136913261, content=<a href='/topic/show?id=d0dc23360b6' target=_blank style='color:#2F92EE;'>#乏力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23360, encryptionId=d0dc23360b6, topicName=乏力)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c2b4297, createdName=徐岩, createdTime=Sat Jun 06 01:30:34 CST 2020, time=2020-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1376898, encodeId=e8f413e689877, content=<a href='/topic/show?id=ddc13e87938' target=_blank style='color:#2F92EE;'>#发烧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37879, encryptionId=ddc13e87938, topicName=发烧)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Sat Jun 06 01:30:34 CST 2020, time=2020-06-06, status=1, ipAttribution=)]
    2020-06-07 fengyqf

    #消瘦#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1742044, encodeId=08291e4204439, content=<a href='/topic/show?id=6e29658163e' target=_blank style='color:#2F92EE;'>#消瘦#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65816, encryptionId=6e29658163e, topicName=消瘦)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6ab635012667, createdName=fengyqf, createdTime=Sun Jun 07 05:30:34 CST 2020, time=2020-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976638, encodeId=4cb619e6638cc, content=<a href='/topic/show?id=acd4943925f' target=_blank style='color:#2F92EE;'>#进行性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94392, encryptionId=acd4943925f, topicName=进行性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=869698, createdName=ligang4439, createdTime=Mon Aug 24 15:30:34 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1369132, encodeId=6d87136913261, content=<a href='/topic/show?id=d0dc23360b6' target=_blank style='color:#2F92EE;'>#乏力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23360, encryptionId=d0dc23360b6, topicName=乏力)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c2b4297, createdName=徐岩, createdTime=Sat Jun 06 01:30:34 CST 2020, time=2020-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1376898, encodeId=e8f413e689877, content=<a href='/topic/show?id=ddc13e87938' target=_blank style='color:#2F92EE;'>#发烧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37879, encryptionId=ddc13e87938, topicName=发烧)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Sat Jun 06 01:30:34 CST 2020, time=2020-06-06, status=1, ipAttribution=)]
    2020-08-24 ligang4439

    #进行性#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1742044, encodeId=08291e4204439, content=<a href='/topic/show?id=6e29658163e' target=_blank style='color:#2F92EE;'>#消瘦#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65816, encryptionId=6e29658163e, topicName=消瘦)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6ab635012667, createdName=fengyqf, createdTime=Sun Jun 07 05:30:34 CST 2020, time=2020-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976638, encodeId=4cb619e6638cc, content=<a href='/topic/show?id=acd4943925f' target=_blank style='color:#2F92EE;'>#进行性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94392, encryptionId=acd4943925f, topicName=进行性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=869698, createdName=ligang4439, createdTime=Mon Aug 24 15:30:34 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1369132, encodeId=6d87136913261, content=<a href='/topic/show?id=d0dc23360b6' target=_blank style='color:#2F92EE;'>#乏力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23360, encryptionId=d0dc23360b6, topicName=乏力)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c2b4297, createdName=徐岩, createdTime=Sat Jun 06 01:30:34 CST 2020, time=2020-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1376898, encodeId=e8f413e689877, content=<a href='/topic/show?id=ddc13e87938' target=_blank style='color:#2F92EE;'>#发烧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37879, encryptionId=ddc13e87938, topicName=发烧)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Sat Jun 06 01:30:34 CST 2020, time=2020-06-06, status=1, ipAttribution=)]
    2020-06-06 徐岩

    #乏力#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1742044, encodeId=08291e4204439, content=<a href='/topic/show?id=6e29658163e' target=_blank style='color:#2F92EE;'>#消瘦#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65816, encryptionId=6e29658163e, topicName=消瘦)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6ab635012667, createdName=fengyqf, createdTime=Sun Jun 07 05:30:34 CST 2020, time=2020-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1976638, encodeId=4cb619e6638cc, content=<a href='/topic/show?id=acd4943925f' target=_blank style='color:#2F92EE;'>#进行性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94392, encryptionId=acd4943925f, topicName=进行性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=869698, createdName=ligang4439, createdTime=Mon Aug 24 15:30:34 CST 2020, time=2020-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1369132, encodeId=6d87136913261, content=<a href='/topic/show?id=d0dc23360b6' target=_blank style='color:#2F92EE;'>#乏力#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23360, encryptionId=d0dc23360b6, topicName=乏力)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c2b4297, createdName=徐岩, createdTime=Sat Jun 06 01:30:34 CST 2020, time=2020-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1376898, encodeId=e8f413e689877, content=<a href='/topic/show?id=ddc13e87938' target=_blank style='color:#2F92EE;'>#发烧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37879, encryptionId=ddc13e87938, topicName=发烧)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Sat Jun 06 01:30:34 CST 2020, time=2020-06-06, status=1, ipAttribution=)]
    2020-06-06 ssnine

    #发烧#

    0