29 余小多 盆腔肿瘤疑难病例讨论-全国肿瘤影像诊断学习班

盆腔病例中国医学科学院肿瘤医院影像诊断科病例一术后病理“右侧卵巢粘液性囊腺瘤”CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences病史CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesT2WI脂肪抑制序列CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences ADC值 ADC值=1.68×10-3mm2/sCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences增强扫描矢状位延迟期增强扫描矢状位延迟期CancerInstitute&Hospital,ChineseAcademyofMedicalSciences增强扫描横断位延迟期CancerInstitute&Hospital,ChineseAcademyofMedicalSciences增强扫描冠状位延迟期增强扫描冠状位延迟期CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences•TCT：有异型腺细胞，考虑为高分化腺癌细胞•活检：颈管内膜组织，小灶腺体增生活跃，因送检组织取材表浅，目前尚不能除外微偏腺癌可能CancerInstitute&Hospital,ChineseAcademyofMedicalSciences临床医师先行宫颈锥切术•锥切标本术中病理提示腺癌，改行经腹广泛全子宫+左侧附件+大网膜+盆腔淋巴结清扫术CancerInstitute&Hospital,ChineseAcademyofMedicalSciences可见一肿物，约5.5×3×1.8cm,切面灰白质硬在多个囊腔形成,部分表面呈息肉CancerInstitute&Hospital,ChineseAcademyofMedicalSciences•宫颈粘液腺癌，大部分呈微偏腺癌，少部分,累及宫体下段，未累及宫颈壁外纤维脂肪组织,双侧宫旁CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences•少见，约占宫颈腺癌的l～3%CancerInstitute&Hospital,ChineseAcademyofMedicalSciences•病理上最可靠的诊断标准是腺体杂乱排列，浸润深度小管分化的性索肿瘤（13-17%伴发Peutz-JegherCancerInstitute&Hospital,ChineseAcademyofMedicalSciences•治疗策略与其他腺癌相仿–早期手术，中晚期放化疗–与临床分期相关CancerInstitute&Hospital,ChineseAcademyofMedicalSciences化CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences–ADC值低CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences长围断CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences•FattanehA.Tavassoli,PeterDevilee,Pathologyandgeneticsoftumoursofthebreastandfemalegenitalorgans.•KaurH,SilvermanPM,IyerRB,etal.Diagnosis,Staging,andSurveillanceofCervicalCarcinomaAJRAmJRoentgenol.2003;180(6):1621-31.•LiuY,BaiR,SunH,LiuH,WangD.Diffusion-weightedmagneticresonanceimagingofuterinecervicalcancer.JComputAssistTomogr2009;33:858-62.•LiuY,YeZ,SunH,BaiR.ClinicalApplicationofDiffusion-WeightedMagneticResonanceImaginginUterineCervicalCancer.IntJGynecolCancer2015;25:1073-8.•KuangF,RenJ,ZhongQ,LiyuanF,HuanY,ChenZ.Thevalueofapparentdiffusioncoefficientintheassessmentofcervicalcancer.EurRadiol2013;23:1050-8.•ParkSB1,LeeJH,LeeYH,etal.Adenomamalignumoftheuterinecervix:imagingfeatureswithclinicopathologiccorrelation.ActaRadiol.2013;54:113-20.•LiG,JiangW,GuiS,XuC.Minimaldeviationadenocarcinomaoftheuterinecervix.IntJGynaecolObstet.2010;110:89-92.•LeeHK,KimSH,ChoJY,etal.UterineAdenofibromaandAdenosarcoma:CTandMRFindings.JComputAssistTomogr.1998;22:314-6lCancerInstitute&Hospital,ChineseAcademyofMedicalSciences病例二CancerInstitute&Hospital,ChineseAcademyofMedicalSciences•查体发现附件区肿物1月•实验室结果:CA125、CA199、CEA均正常CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesDWIT1双回波-正相位DWIT1双回波-正相位T2T2WI/FS-AXT1T1双回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesDWIT1双回波-正相位DWIT1双回波-正相位T2T2WI/FS-AXT1T1双回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesDWIT1双回波-正相位DWIT1双回波-正相位T2T2WI/FS-AXT1T1双回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesDWIT1双回波-正相位DWIT1双回波-正相位T2T2WI/FS-AXT1T1双回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesT2T2WI/FS-AXT1T1双回波-正相位DWIDWIT1T1双回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesT2T2WI/FS-AXT1T1双回波-正相位DWIDWIT1T1双回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences动态增强扫描CancerInstitute&Hospital,ChineseAcademyofMedicalSciences动态增强扫描CancerInstitute&Hospital,ChineseAcademyofMedicalSciences动态增强扫描动态增强扫描CancerInstitute&Hospital,ChineseAcademyofMedicalSciences矢状位延迟增强扫描CancerInstitute&Hospital,ChineseAcademyofMedicalSciences冠状位延迟增强扫描CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences来源于卵巢生殖细胞，发病率约占卵巢肿瘤10～20%组织发生来自减数分裂前细胞CancerInstitute&Hospital,ChineseAcademyofMedicalSciences•病理主要分为4型–成熟畸胎瘤：良性，最常见（97%），育龄期妇女，单囊为主/多囊，囊内含毛发和皮质样物，囊壁头节，头节处可含多胚层组织–未成熟畸胎瘤，较少见，占卵巢畸胎瘤的3%，年轻患者，组织来源除三胚层成熟组织外，上可见未成熟组织，约32~58%发生转移围组织，较少发生淋巴管或学行转移–单胚层或高度特异的肿瘤：卵巢甲状腺肿、类癌和腺类癌、CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences•最常见的单胚层肿瘤，占卵巢全部畸胎瘤的2.7%，全部卵巢肿瘤的0.3%可分泌甲状腺激素、甚至引起甲亢CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences,则边界不清CancerInstitute&Hospital,ChineseAcademyofMedicalSciences性或实性成分为主的少见•单囊者信号均匀，多囊者囊腔内信号不一•囊壁及分隔较厚，可见钙化灶•增强扫描甲状腺组织显著强化，囊内容物无明显强化CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences•囊肿大小不一•出血时间不同，囊内信号各异•边缘不规则，囊肿壁与邻近结构分界不清CancerInstitute&Hospital,ChineseAcademy