患者，男，39岁，右膝肿物，疼痛伴活动受限2个月，近日感肿物逐渐增大，无发热。
查体：右膝扪及一肿物，质硬，局部皮温无增高，内侧压痛明显，右膝活动受限。实验室检查无异常。
上期试题：强直性脊柱炎最常累及？
A．脊柱
B．手关节
C．髋关节
D．骶髂关节
E．膝关节
患者，男，39岁，右膝肿物，疼痛伴活动受限2个月，近日感肿物逐渐增大，无发热。
查体：右膝扪及一肿物，质硬，局部皮温无增高，内侧压痛明显，右膝活动受限。实验室检查无异常。
平片：右股骨远端可见大片状溶骨性骨质破坏，呈虫蚀样，局部骨皮质中断、缺损，边缘轻度硬化，周围软组织肿胀。
CT平扫：右股骨远端见地图样。虫蚀样骨质破坏及软组织肿块影，其内密度不均，边缘不清，骨破坏间夹杂粗细不等的骨嵴及钙化灶，局部骨皮质掀起并见骨外软组织肿块影。
冠状位T2WI、冠状位T2WI、冠状位T2抑脂像
右股骨远端骨质破坏，并形成软组织肿块影，于T1WI像上呈低信号，T2WI像上呈低信号，T2WI抑脂像上呈不均匀高信号，边界不清。
横轴位T1WI抑脂增强、冠状位T1WI抑脂增强、矢状位T1WI抑脂增强扫描
骨质破坏区及周围软组织肿块呈明显不均匀强化。
骨恶性纤维组织细胞瘤，男性多见，多为单发，好发年龄为30-70岁。发病部位以四肢长骨为多，尤其股骨、胫骨及肱骨，临床表现以疼痛、活动障碍为主。
Bone malignant fibrous histiocytoma, male more, more single hair, good hair age 30-70 years old. The site of the disease is a lot of extremities, especially femur, tibia and humerus, and the clinical manifestations are mainly pain and activity disorder.
病理表现：肿瘤由间变的成纤维细胞、组织细胞样细胞、肌纤维母细胞、原始间充质细胞、瘤巨细胞、异型多核巨细胞及黄色瘤样细胞等多种成分构成，无瘤性成骨现象。因MFH病理上瘤细胞的多样性，该病的影像学表现也很复杂，兼有良性及恶性骨肿瘤的影像特点，概括为：
1、骨质破坏是MFH主要影像学表现，常见地图样、虫蚀样、斑片状骨质破坏。
2、骨质硬化及钙化，骨破坏区内见斑点状、斑块状钙化及硬化。
3、软组织肿块影，超过骨质破坏范围的软组织肿块是MFH的一个特征。
4、骨膜反应，无或少有骨膜反应。
Pathological manifestations: between tumor by change of fibroblast cells, muscle fiber mother cell, tissue and cell ectomesenchymal cells original, tumor giant cells, multinucleated giant cells and xanthoma cells and so on the many kinds of chemical composition, disease-free osteogenesis phenomenon. Because of the diversity of tumor cells in MFH pathology, the imaging performance of the disease is also complex, and the imaging features of both benign and malignant bone tumors are summarized as follows:
1. Bone destruction is the main imaging performance of MFH, and the common pattern, insect etching, and patchy bone destruction.
2. Bone sclerosis and calcification, spot, plaque calcification and hardening in the area of bone destruction.
3. Soft tissue mass, which is more than the extent of bone destruction, is a feature of MFH.
4. Periosteal reaction, no or little periosteal reaction.
本例骨恶性纤维组织细胞瘤为中年男性，因膝关节疼痛、活动受限就诊，影像学以骨质破坏、软组织肿块为主要表现，骨破坏区间以骨质硬化、钙化，符合骨恶性纤维组织细胞瘤的表现。
The cases of malignant fibrous histiocytoma of bone for middle-aged men, see a doctor because of knee pain and restricted movement, radiographic bone destruction and soft tissue mass as the main performance, bone destruction interval with bone sclerosis, calcification, accord with malignant fibrous histiocytoma of bone.
本例应与溶骨性骨肉瘤鉴别。溶骨性骨肉瘤好发于青少年，肿块于T2WI像上呈高信号。当出现骨膜反应及肿瘤骨时可协助鉴别。
This example should be identified with osteosarcoma. Osteosarcoma of osteolytic osteosarcoma occurs in adolescents, and the mass is high in T2WI. Can be assisted to identify when periosteal reaction and tumor bone are present.
本期试题：瘤细胞呈带状、索条状或蝌蚪状，胞浆红染，部分瘤细胞胞浆内可见纵纹和横纹，该恶性肿瘤最可能是：
A．恶性纤维组织细胞瘤
B．横纹肌肉瘤
C．脂肪肉瘤
D．骨肉瘤
E．视网膜母细胞瘤
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