【腹部】子宫恶性肿瘤的MRI诊断课件

2009-8-7

Hospital2

子宮惡性腫瘤的流行病學現狀

Epidemiology

of

Uterine

Malignant

Neoplasm子宮惡性腫瘤包括子宮頸癌、子宮內膜癌、滋養細

胞惡性腫瘤、子宮肉瘤等Uterine

malignant

neoplasm

includes

cervical

carcinoma,

endometrial

carcinoma,

uterine

sarcoma

and

malignant

trophoblastic

tumor,

etc.2009-8-7

Hospital3nnnn全球婦女惡性腫瘤發病率的第三位

The

No.

3

female

malignant

tumor

in

the

world我國婦科惡性腫瘤發病率的前兩位

The

top

two

common

female

cancer

in

China女性惡性腫瘤死亡率的第二位

The

second

mortality

in

female

malignant

tumor

in

China每年約有3萬名婦女死於宮頸癌

About

30,000

females

died

子宮頸癌Cervical

Carcinoma2009-8-7

Hospital4nnn全球婦女惡性腫瘤發病率的第四位The

fourth

most

common

female

cancer

in

the

world每年的平均病例數是30

年前的40

倍之多The

yearly

average

number

of

endometrial

carcinoma

is

nearlyfourty

times

as

much

as

those

30

years

ago隨著我國婦女內分泌代謝性疾病的增加，子宮內膜癌呈對數速度增長With

endocrinopathy

morbidity

rising,

the

number

of

endometrialcarcinoma

is

increasing

according

to

logarithm

fashion

子宮內膜癌Endometrial

carcinoma2009-8-7

Hospital5nnn占子宮惡性腫瘤的2

%

–

4

%

Accounting

for

2

–

4

%

of

all

uterine

malignancies占生殖道惡性腫瘤的1%

Accounting

for

1%

of

all

malignancies

in

female

reproductive

tract臨床罕見、惡性程度較高

A

very

rare

and

high

malignancy

in

female

reproductive

tract

子宮肉瘤Uterine

sarcoma2009-8-7

Hospital6子宮惡性腫瘤的臨床檢查方法

Clinical

examination

of

uterine

malignant

neoplasm2009-8-7

Hospital7

臨床檢查

Clinical

examinationp普通婦科檢查：簡單，但具有明顯的局限性

Gynecological

examination

:

simple

&

limitedp分期具有主觀性：34％－39％的患者分期錯誤

Subjectivity

on

its

staging:

34%-39%

of

incorrect

stagingp不能全面評價腫瘤侵犯深度和盆腔淋巴結轉移

Difficult

to

identify

invasive

extent

and

lymph

node

metastases2009-8-7

Hospital8

臨床檢查-細胞學檢查Clinical

examination-Exfoliative

cytologic

examination

n檢測來源於子宮內膜、子宮頸的惡性細胞

Finding

malignant

cells

from

cervix

and

uterine

endometrium

n為子宮惡性腫瘤的診斷診斷提供直接依據

Providing

direct

diagnosis

for

uterine

malignant

neoplasm

n為子宮微生物感染提供診斷依據

Finding

foundation

for

uterine

microbial

infection

n在腫瘤的分期上無明顯價值

No

value

on

its

staging2009-8-7

Hospital9

臨床檢查-陰道宮腔鏡Clinical

examination--

hysteroscopynnn對子宮可疑病變進行定位活檢Biopsy

for

suspected

lesion明顯提高子宮體、頸部早期癌的診斷率Higher

diagnostic

rate

of

uterine

and

cervical

cancer不能客觀評價腫瘤侵犯深度和盆腔淋巴結轉移Unable

to

evaluate

invasive

extent

and

lymphnodes

metastasisaccurately2009-8-7

Hospital10

影像學方法-超聲檢查Medical

image

examination-Ultrasonographyppp

對子宮可疑病變進行定位活檢The

most

common

screen

on

uterine

malignant

tumor

經腹超聲在分期上應用價值較小Trans-abdominal

ultrasound

with

few

value

on

staging

陰式超聲可明顯提高子宮惡性腫瘤的分期，

其陽性、陰性預測值分別約62％和92％

Improving

staging

by

trans-vagina

ultrasound

with

62%

for

positive

predictive

value

and

92%

for

negative

predictive

value2009-8-7

Hospital11

影像學方法-

CT檢查Medical

image

examination-CTnnn平掃CT：子宮惡性腫瘤與子宮壁密度相似，難以顯示癌腫的浸潤深度和範圍Non-CE

CT:

difficult

to

show

tumor

invasive

depth

and

extent

becauseof

similar

intensity

between

uterine

tissues

&

malignant

tissuesCT增強：子宮惡性腫瘤顯示有局限性Showing

uterine

disease

with

some

limitations

by

CE

CTCT評價宮旁浸潤假陽性較高，準確度僅33％－58％Accuracy

is

33％－58％

on

evaluating

parametrical

invasion

by

CTbecause

of

a

high

false-positive

error2009-8-7

Hospital12

影像學方法-

MRMedical

image

examination--MRInn上世紀80年代，MRI出現並應用於子宮腫瘤的診斷

MRI

used

in

uterine

diagnosis

in

the

last

80's當時，成像時間長、圖像易受呼吸、血管搏動和腸蠕動的影響、磁場強度低等缺點使其應用受限At

that

time,

longer

imaging

time

&

imaging

quality

easily

disturbed

bybreath,

vessel

pause,

bowel

movement,

low

magnetic

field

strengt,

etc.These

disadvantages

limited

its

application2009-8-7

Hospital13nn隨著MRI場強、梯度切換率的提高和多通道高密相控陣線圈的應用，使應用MRI技術對子宮惡性腫瘤進行準確診斷和客觀評價成為可能With

high-magnetic

MR

scanner,high-gradient

switch

ratio

andmultiple

phased

array

coils,

it

is

possible

to

diagnose

uterinemalignacy

accurately

and

evaluate

it

objectively

by

MRIMRI因其極高的軟組織分辨力，能夠清晰顯示子宮的組織結構和信號的細微變化，近而準確評價子宮惡性腫瘤的大小和範圍Clearly

displaying

uterine

layers,

signal

changes,

tumor

size

andextent

on

MRI

image

because

of

it

high

soft

tissue

resolution2009-8-7

Hospital14nn腫瘤分期達到Ⅰb期以上，MRI的評價準確性、陽性和陰性預測值分別可達81％－

95%、100％、90%Above

IB

staging,

accuracy,

positive

predictive

value

and

negativepredictive

value

of

MRI

evaluation

:

81%-95%,100%

and

90%在顯示子宮惡性腫瘤宮旁浸潤和淋巴結轉移等方面，其敏感度、特異度均較高High

sensitivity

and

specificity

in

showing

parametrical

invasion

andlympnode

metastasis

from

uterine

malignant

neoplasm

on

MRI2009-8-7

Hospital15

影像學方法-

PETCT檢查Medical

image

examination-PEC/CTnnn是評價子宮腫瘤良惡性的最佳影像方法之一One

of

the

best

evaluations

on

uterine

malignancy對腫瘤及周圍淋巴結轉移進行客觀評價，其特異性高，陽性預測值約75%-100%Objective

view

on

tumor

and

lymph

node

metastasis

with

75%-100%

positive

predictive

value昂貴的價格制約了其廣泛應用Application

limited

by

expensive

costing2009-8-7

Hospital16MRI在子宮惡性腫瘤診斷上的價值

Diagnostic

Value

of

MRI

in

Uterine

Malignant

Neoplasm2009-8-7

Hospital17MRI成像的優勢

Advantage

of

MRInnnn無損傷和輻射性

No

injury

and

radiation高的軟組織分辨力和極高的敏感度

High

soft

tissue

resolution

and

sensitivityMRI三維成像使病灶定位更準確

3D

images

with

high

accuracy

in

lesions檢出子宮多灶性病變以及評價侵犯的範圍、周圍淋巴結轉移區域有明顯價值Identifying

multiple

lesions,invasive

extending

and

lymph

nodemetastasis2009-8-7

Hospital18nn動態增強檢查可瞭解病變的血流灌注情況,有助於病變性質的評價Exploring

perfusion

&

evaluation

of

tumors

by

DCT為準確分期和臨床治療方案的制定提供可靠依據Providing

accurate

staging

and

therapy

planning2009-8-7

Hospital19

子宮MRI檢查的適應症Indications

of

uterine

MRI

examinationnnnnn檢出子宮隱匿性病灶、囊性病灶及多灶性病變

Detecting

occult,

cystic

and

multiple

lesions評價子宮惡性腫瘤的浸潤範圍和淋巴結轉移

Evaluating

invasive

extent

and

lympnode

metastasis評價子宮惡性腫瘤的新輔助治療療效

Evaluateing

therapy

effect確定手術適應症

Determining

surgical

indications監測子宮惡性腫瘤的術後復發

Monitoring

post-surgical

recurrence2009-8-7

Hospital20子宮惡性腫瘤的MRI診斷、分期

Diagnosing

and

Staging

of

Uterine

Malignant

Neoplasm

by

MRI2009-8-7

Hospital21（一）子宮內膜癌

Endometrial

Carcinoma2009-8-7

Hospital22

子宮內膜癌的臨床特徵Clinical

Characters

of

Endometrial

Carcinomann

臨床表現：絕經後婦女陰道不規則流血、

惡臭液體及爛肉,下腹疼痛、消瘦和貧血

Clinical

manifestations:

postmenopausal

women

with

irregular

vaginal

bleeding,

foul

liquid,necrotic

tissue,

abdominal

pain,

weight

loss

and

anemia

好發部位：子宮底和體後壁Occurrence

sites:

the

posterior

wall

of

uterus

and

its

bottom2009-8-7

Hospital23擴散方式The

spreading

waysØØØ直接播散Direct

spreading淋巴轉移Lymph

node

metastasis血行轉移Hematogenous

metastasis2009-8-7

Hospital24

子宮內膜癌的MRI特徵

MRI

Characters

of

Endometrial

Carcinoma病變局限於內膜Lesions

confined

in

endometrialnnnT1WI：癌腫信號稍低於內膜或與肌層信號一致T1WI:

endometrial

carcinoma

signal

is

slightly

lower

than

theendometrial

signal

or

same

as

the

myometrial

signalT2WI：內膜局限/彌漫增厚，呈稍高信號

T2WI:

hyper-signal

in

limitations

/

diffuse

thickening

endometrial病變不強化或輕度強化，低於肌層Slightly

or

no

enhanced

contrast

with

a

signal

lower

than

myometrial2009-8-7

Hospital25病變侵入肌層Invading

myometrialnnn癌腫呈菜花狀、息肉狀突入宮腔lesions

with

cauliflower-like

mass

in

the

uterine

cavityT2WI:低信號的結合帶內出現高信號T2WI:

hyper-signal

in

lower

junctional

zone增強時:肌層病變與內膜病變均呈低信號，強化的結合帶不完整CE:

lesion

with

low

signals

in

both

myometrial

and

endometriallayers,

showing

incompletely

enhanced

changes

in

the

junctionalzone2009-8-7

Hospital26深肌層受侵Deep

myometrial

invasionnn子宮各層結構消失,

局部肌層出現不規則低信號病灶，肌層變薄

Disappearance

uterine

layers

with

focused,

irregular

low-signallesions

in

myometrium

&

thinning

myometrium子宮增大,

盆腔內組織器官廣泛受侵

Enlarged

uterus,

diffusion

involvement

in

pelvic

tissues

&

organs2009-8-7

Hospital27nnnnⅠa:腫瘤僅局限於子宮內膜Ⅰa

:Tumor

confined

in

endometriumⅠb:子宮肌層受侵小於1/2Ⅰb:

invaded

myometrial

less

than

1/2Ⅰc:子宮肌層受侵大於1/2Ⅰc:

invased

myometrial

more

than1/2Ⅱa:宮頸內膜受侵Ⅱa:

invasion

into

cervical

endometrial

子宮內膜癌的臨床分期

Staging

of

Endometrial

Carcinoma採用國際婦產科聯盟分期標準From

International

Federation

of

Gynecology

and

Obstetrics,

FIGO2009-8-7

Hospital28nnnnnn

Ⅱb:腫瘤侵犯到宮頸基質外

Ⅱb:

invasion

into

cervical

stromal

outside

Ⅲa:附件受侵或穿出漿膜/腹腔積液細胞學(＋)

Ⅲa:

out

of

the

annex

or

serosal

invasion/peritoneal

fluid

cytology

(+)

Ⅲb:陰道擴散

Ⅲb:

the

spread

of

the

vagina

Ⅲc:盆腔或主動脈周圍淋巴結轉移

Ⅲc:

pelvic

lymph

node

metastasis

around

the

aorta

Ⅳa期:膀胱或直腸受侵Ⅳa:

involvement

of

bladder

or

rectum

Ⅳb期:遠處轉移或腹部、腹股溝淋巴結轉移

Ⅳb:

distant

metastasis

or

the

abdomen,

groin

lymphnode

metastasis2009-8-7

Hospital292009-8-7

Hospital30肌層受侵小於

Cancer

Institute

and2009-8-7Hospital31

子宮內膜癌Ib

期

55歲--StageⅠb

endometrial

carcinoma

in

a

55-year-old

woman

T2WIT1WIT2WI

1/2

LiaoningInvaded

myometrial

less

than

1/2Invased

myometrial

more

than1/2T2WI

2009-8-7T1WI

32

子宮內膜癌Ic期

40歲--Stage

Ic

endometrial

carcinoma

in

a

40-year-old

woman

CE:

T1WICE:

T1WI

肌層受侵大於1/2

Hospital

Hospital33

2009-8-7Copyright

©

2007

by

the

American

Roentgen

Ray

Society

子宮內膜癌IIa期

78歲----Stage

IIa

endometrial

carcinoma

in

a

78-year-old

woman宮頸內膜受侵

Invasion

into

cervical

endometrialSala,

E.

et

al.

Am.

J.

Roentgenol.

2007;188:1577-1587T2WIT2WI2009-8-7

Hospital34

子宮內膜癌Ⅲa期----Stage

Ⅲa

endometrial

carcinoma雙側卵巢受侵tumor

invading

the

ovaries

T2WIT2WI

Hospital35

子宮內膜癌Ⅲb期

----Stage

Ⅲb

endometrial

carcinoma肌層受侵大於1/2伴陰道擴散Deep

invasion

>50%

of

the

myometrialthickness

of

endometrial

carcinoma(arrow).The

spread

of

the

vagina2009-8-7T2WI2009-8-7

Hospital36Riccardo

et.al

子宮內膜癌Ⅲc期

----Stage

Ⅲc

endometrial

carcinoma肌層受侵大於1/2伴閉孔內淋巴結轉移Deep

invasion

>50%

of

the

myometrialthickness

of

endometrial

carcinoma

(arrow)and

internal

obturator

lymph

node

metastasis

T2WIRadiology

2004

18

(

10).11482009-8-7

Hospital37

T2WI直腸受侵Involvement

of

rectumT2WI

子宮內膜癌Ⅳa期----Stage

Ⅳa

endometrial

carcinomaT2WIT1WI2009-8-7

Hospital38Jpn

Clinica

lRadol

50（11）1514-1515Involvement

of

bladder

子宮內膜癌Ⅳa期

----Stage

Ⅳa

endometrial

carcinoma

T2WI

T2WI膀胱受侵2009-8-7

Hospital39

子宮內膜癌Ⅳb期

----Stage

Ⅳb

endometrial

carcinoma宮頸受侵、腹部多發轉移Invasion

into

cervical

and

abdomenmetastasis2009-8-7

Hospital40（二）子宮頸癌

Cervical

carcinoma2009-8-7

Hospital41nnn病因:尚不清，可能與婦女性生活、生育史、生殖道病毒或細菌感染、性病、種族、地理和營養狀況等相關Etiology:

not

clearly,

maybe

related

with

sexual

life,

reproductive

history,reproductive

tract

virus

or

bacterial

infection,

sexually

transmitteddiseases,

race,

geography

and

nutrition腫瘤來源:95%為宮頸鱗狀上皮；5%為宮頸管腺上皮Oncology

resource

:

95%

from

cervical

squamous

cell;

5%

from

thecervical

epithelium好發部位：鱗狀上皮和柱狀上皮間的移行區Ocurrence

site:

transitional

zone

between

squamous

epithelium

andcolumnar

epithelium

子宮頸癌的臨床特徵Clinical

Characters

of

Cervical

Carcinoma2009-8-7

Hospital42nn臨床表現：陰道出血是主要徵象，可以是自然出血或接觸性出血，合併感染時白帶增多Clinical

:

the

main

symptom

:

vaginal

bleeding

with

natural

or

contactbleeding,

white

discharge

infection擴散方式：深部浸潤、直接蔓延、淋巴轉移，血行轉移少The

spreading:

deep

infiltration,

direct

spreading,

lymph

nodemetastasis,

hematogenous

metastasis43nⅠ期：限於宮頸

Stage

Ⅰ

–

confined

to

the

cervix

ØⅠa:早期鏡下浸潤

Ⅰa

-

Diagnosed

only

by

microscopy;

no

visible

lesionsØØⅠa1期:微灶浸潤深度小於3mm,寬度小於7mm

Ⅰa1

-

stromal

invasion

less

than

3

mm

in

depth

and

7

mm

or

less

in

horizontal

spreadⅠa2期:融合性浸潤，深度在3-5mm，寬度＜7mm

Ⅰa2

-

stromal

invasion

between

3

and

5

mm

with

horizontal

spread

of

7

mm

or

less

2009-8-7

Hospital

子宮頸癌的臨床分期

Staging

of

Cervical

Carcinoma採用國際婦產科聯盟分期標準From

International

Federation

of

Gynecology

and

Obstetrics,

FIGO2009-8-7

Hospital44ØØØⅠb期：浸潤深度>5mm，寬度>7mmⅠb

-

visible

lesion

or

a

microscopic

lesion

with

more

than

5

mm

ofdepth

or

horizontal

spread

of

more

than

7

mmⅠb1期：病灶可視最大徑<40mmⅠb1

-

visible

lesion

4

cm

or

less

in

greatest

dimensionⅠb2期：病灶可視最大徑>40mmⅠb2

-

visible

lesion

more

than

4

cmn

Ⅱ期：癌灶超越宮頸Stage

Ⅱ

–

involved

in

cervixØØⅡa:癌腫未達到骨盆壁，累及陰道上部2/3

Ⅱa

–

no

parametrial

invasion,

but

involved

in

upper

2/3

of

vaginaⅡb:宮頸旁組織浸潤

Ⅱb

-

parametrial

invasion2009-8-7

Hospital45n

Ⅲ期：癌腫累及陰道下1/3和/或達到骨盆壁Stage

III

-

extends

to

pelvic

wall

or

lower

third

of

the

vaginaØØ

Ⅲa期：癌腫累及陰道下1/3

Ⅲa

-

involves

lower

1/3

of

vagina

Ⅲb期：骨盆壁累和/或腎盂積水或無功能腎ⅢB

-

extends

to

pelvic

wall

and/or

causes

hydronephrosis

or

non-

functioning

kidneynⅣ期：癌腫累及真骨盆以外部分或累及膀胱或直腸(Ⅳa)，到達遠處器官(Ⅳb)ØØⅣa

-

invades

mucosa

of

bladder

or

rectum

and/or

extends

beyond

truepelvisⅣb

-

distant

metastasis2009-8-7

Hospital462009-8-7

Hospital472009-8-7

Hospital48/best-practi...2009-8-7

Hospital49http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100

-39842007000300014&tlng=en&lng=en&nrm=iso2009-8-7

Hospital50nnnMRI軸位上顯示為類圓形和不規則形分葉腫塊MRI:

a

round,

irregular-shaped

and

lobulated

mass

on

axial

MRI矢狀位顯示宮頸增大為桶狀，宮頸管腔消失Enlarged

cervix

with

barrel

shape

on

sgaiggtal

imagingT1WI呈等信號，T2WI呈高信號the

disappearance

of

cervical

cannel

iso-signal

on

T1WI;

hyper-signal

on

T2WI

子宮頸癌的MRI特徵

MRI

Characters

of

Cervical

Carcinoma癌腫的MRI表現MRI

Characters

of

lesion2009-8-7

Hospital51nnT2WI:癌腫與正常宮頸基質低信號及宮旁脂肪間隙有良好對比

T2WI:

good

contrast

between

the

tumor

and

normal

cervicalstroma

with

low

signal

&

parametrial

space增強動態掃描，T1WI癌腫早期強化，可清晰顯示病灶的形態、邊界和宮頸基質受侵犯的深度CE:

obviously

showing

enhanced

tumor

with

shape

and

rimand

the

depth

of

cervical

stromal

invasion2009-8-7

Hospital52癌腫侵犯深度的MRI評價Tumor

invasion

depth:

evaluation

by

MRInn局限於粘膜內：浸潤深度＜5mm，T1WI與T2WI呈中等信號，與正常粘膜接近;增強掃描可依據早期強化的癌腫清晰顯示病灶的邊緣及其浸潤的深度Confined

in

mucosa:

the

invasion

depth

<5mm;

iso-signal

on

T1WI

andT2WI,

showing

similar

signal

with

nearly

normal

mucosa

and

enhancedlesion

with

clear

rim

and

invasive

depth

on

contrast-enhanced

image病變侵犯基質：T2WI低信號的基質環被癌腫高信號部分或完全取代時，即使外緣光整，也提示基質受侵Invaded

stroma

by

lesion:

hypo-signal

on

T2WI

replaced

by

tumor

as

asmooth

rim,

demonstrating

a

complete

or

partial

damage

in

cervicalstroma2009-8-7

Hospital53nn病變侵犯宮體：T2WI子宮體增大，低信號的結合帶被高信號的癌腫組織取代/內外帶顯著不規則Invaded

uterine

corpus

by

lesion:

enlarged

uterus

corpus

on

T2WI,junctional

zone

replaced

by

hyper-signal

of

tumor,

showingirregular

changes

on

hypo-signal

of

inner

and

latter

zone病變侵犯宮旁：T1WI雙側宮旁不對稱，宮頸外緣不規則，低信號的宮旁組織出現稍高信號腫塊；增強後，腫塊明顯強化T1WI:invaded

uterine

corpus

by

lesion,

showing

unsymmetricalparametrial

changes

and

irregular

rim

on

cervix

with

hyper-signalmass

with

clear

enhancement

in

hypo-signal

parametrial

tissue2009-8-7

Hospital54

子宮頸癌Ib期

36歲----Stage

Ⅰb

cervical

carcinoma

in

a

36-year-old

woman

T2WI浸潤深度>5mm，寬度>7mmStromal

invasion

more

than5

mm

in

depth

and

morethan7

mm

in

horizontal

spreadT1WIT2WI2009-8-7

Hospital55浸潤深度>5mm，寬度>7mmStromal

invasion

more

than5

mm

in

depth

and

morethan7

mm

in

horizontal

spread

子宮頸癌Ib期----Stage

Ⅰb

cervical

carcinoma

T2WIT2WI2009-8-7

Hospital56

子宮頸癌Ⅱa期

34歲----Stage

Ⅱa

cervical

carcinoma

in

a

34-year-old

womanT2WIT2WIT2WIT1WI癌腫累及陰道上部2/3involved

in

upper

2/3

ofvagina2009-8-7

Hospital57

子宮頸癌Ⅱb期

47歲----Stage

Ⅱb

cervical

carcinoma

in

a

47-year-old

woman宮頸旁組織浸潤parametrial

invasionT2WI

T2WISala,

E.

et

al.

Am.

J.

Roentgenol.

2007;188:1577-158758

子宮頸癌Ⅱb期----Stage

Ⅱb

cervical

carcinoma宮頸旁組織浸潤parametrial

invasion

2009-8-7T2WIT2WI

T2WI

HospitalT2WI

Hospital59

2009-8-7Copyright

©

2007

by

the

American

Roentgen

Ray

Society

子宮頸癌IIb期

42歲--Stage

IIb

cervical

cancer

in

42-year-old

woman

T2WI宮頸旁組織浸潤parametrial

invasion

T2WISala,

E.

et

al.

Am.

J.

Roentgenol.

2007;188:1577-15872009-8-7

Hospital60

子宮頸癌IIIa期

45歲

--Stage

Ⅲa

cervical

cancer

in

45-year-old

woman

T2WI累及陰道下1/3extends

to

the

lower

1/3

of

vagina

T2WI2009-8-7

Hospital61

子宮頸癌IVa期

39歲--Stage

Ⅳa

cervical

cancer

in

39-year-old

woman

T2WI累及直腸extends

to

rectum

T2WISala,

E.

et

al.

Am.

J.

Roentgenol.

2007;188:1577-1587

Hospital62

2009-8-7Copyright

©

2007

by

the

American

Roentgen

Ray

Society

子宮頸癌IVa期--Stage

Ⅳa

cervical

cancer累及膀胱extends

to

rectum

and

bladder

T2WISala,

E.

et

al.

Am.

J.

Roentgenol.

2007;188:1577-15872009-8-7

Hospital63（三）子宮肉瘤

Uterine

Sarcoma2009-8-7

Hospital64nnn病因：尚不清Etiology:

unclear腫瘤來源:子宮平滑肌、子宮內膜間質、血管、纖維組織Oncology

Source:

uterine

smooth

muscle,

endometrial

stromal,

vascular,fibrous

tissues病理分類：子宮平滑肌肉瘤、子宮內膜間質肉瘤、混合型同源mullerian肉瘤、混合型異源mullerian肉瘤Pathological

classification:

uterine

leiomyosarcoma,

endometrial

stromalsarcoma,

homologous

mixed

mullerian

sarcoma,

mixed

mullerianheterologous

sarcoma

子宮肉瘤的臨床特徵Clinical

Characters

of

Uterine

Sarcoma2009-8-7

Hospital65臨床表現Clinical

manifestationsnnnn最常見症狀不規則陰道出血Common

symptoms--

irregular

vaginal

bleeding腫瘤生長過快、過度膨脹或瘤內出血壞死Excessive

tumor

growth,

excessive

swelling

or

bleeding

andnecrosis腹痛及腫瘤的壓迫症狀Symptoms

of

oppression

and

pain觸及腹部包塊Palpable

abdominal

mass2009-8-7

Hospital66nn

生長方式：多數為彌漫性生長，與肌層分界不

清，無包膜

Growth

:

the

majority

of

them

having

diffuse

growth

with

unclear

boundaries

between

muscular

and

tumor

and

without

envelope

擴散方式：直接侵犯、淋巴轉移、血行轉移Spreading:

direct

invasion,lymphatic

metastasis,

hematogenous

metastasis2009-8-7

Hospital67nnnn子宮肉瘤的MRI表現無特異性No

specific

findings

on

MRI

of

uterine

sarcoma子宮肉瘤較之其他腫瘤，體積一般較大Compared

with

other

tumo