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患者女,60岁,B超发现“盆腔包块”1年。CT:膀胱左前壁肿块,边界清晰,大小4.2cm×5.2cm×3.8cm,位于膀胱壁内外,密度略不均匀;动脉期明显不均匀强化,瘤周较多纡曲血管影;延迟期持续强化。CTA示病灶由膀胱下动脉分支供血,呈血管包绕征(图1A)。MRI:膀胱肿块呈T1WI等、低信号,T2WI等、高信号;DWI示病灶不均匀高信号(图1B);增强扫描明显不均匀持续强化,瘤周血管扩张(图1C)。行膀胱全切除术,术中见肿瘤位于膀胱左前壁,质韧。病理:瘤组织由梭形和上皮样细胞组成,间质血窦丰富。免疫组化:HMB45(+,图1D),PNL2(+),PGP9.5(+),CD99(+)。病理诊断:膀胱壁血
Female patient, 60 years old, B-ultrasound found “pelvic mass” for 1 year. CT: bladder left anterior wall mass, clear boundary, the size of 4.2cm × 5.2cm × 3.8cm, located in the bladder wall inside and outside, the density is slightly uneven; arterial phase was significantly enhanced, more peri-mal vascular imaging; delay continued strengthen. CTA showed lesions by the branch of the inferior umbilical artery blood supply, showed vascular wrap sign (Figure 1A). MRI: T1WI bladder tumor showed low, T2WI, etc., high signal; DWI showed uneven high signal lesions (Figure 1B); enhanced scan was significantly enhanced non-uniform, perivascular vasodilation (Figure 1C). Total line resection of the bladder, the tumor see the tumor in the left anterior wall of the bladder, quality and toughness. Pathology: tumor tissue by spindle and epithelial cells, interstitial blood sinus rich. Immunohistochemistry: HMB45 (+, Fig. ID), PNL2 (+), PGP9.5 (+), CD99 (+). Pathological diagnosis: bladder wall blood