纵隔内胚窦瘤CT表现与病理对照分析  

Primary mediastinal endodermal sinus tumor:CT findings and pathologic correlation

作　　者：张岳[1,2,3] 张金娥 赵振军[1,2] 刘再毅[1,2] 吴政光[4] 梁长虹[1,2] 

机构地区：[1]广东省人民医院影像医学部 [2]广东省医学科学院,广州510080 [3]南方医科大学,广州510515 [4]广东省第二人民医院放射科,广州510317

出　　处：《放射学实践》2013年第6期632-635,共4页Radiologic Practice

摘　　要：目的:探讨纵隔内胚窦瘤(PMEST)的CT表现,旨在提高对PMEST的CT诊断水平。方法:回顾分析10例经病理证实PMEST临床、病理及CT资料,将CT表现与病理结果对照。本组病例年龄11～38岁,平均19岁,其中男∶女=8∶2。结果:10例PMEST病灶均局限于前纵隔,居中4例,偏右/左侧6例;最大径为6.9～15.0cm,平均10.7cm;局部边界不清,类圆形6例,不规则形4例。平扫显示肿块密度不均,呈"蜂窝状"低密度为主,CT呈低密度区,组织学检查,镜下见大片粘液和坏死;CT呈等/稍高密度间隔和实质部分,镜下见大量纤维增生。1例病灶内见钙化。动态增强扫描动脉期显示间隔和实质部分中度强化;其中4例行延迟扫描可见间隔和蜂窝轻微延迟强化,组织学检查镜下见蜂窝内富含粘液样基质以及黏液样变性。所有病例均未见肿大淋巴结。纵隔大血管及心脏均不同程度受压、推移。上腔静脉受侵2例,左头臂静脉受侵2例;7例合并心包积液,4例合并胸腔积液。所有病例AFP均显著升高(>1000ng/ml)。结论:青少年男性、前纵隔、巨大肿块,CT平扫及增强呈"蜂窝状"改变,延迟扫描间隔和蜂窝延迟强化,结合AFP明显升高应考虑PMEST的诊断。Objective：To study the CT manifestations of primary mediastinal endodermal sinus tumor （PMEST） and to improve the CT diagnosis of PMEST. Methods：The CT and pathological findings and clinical data of 10 cases of patho logically confirued PMEST were retrospectively analyzed. There were 8 males and 2 females,aged 11 to 38 years （mean 19）. Results： All ten lesions of PMEST located in auterior mediastinum,four of ten situated centrally and 6 of I0 at right or left side. The maximal diameter of lesions was 0.9 -15.0cm （mean 10.7cm）. They were ill defined, round （n=6） or irregu- lar shaped （n= 4）. On plain scan,the tumor showed heterogeneous denisity and honeycomb hypodense structure. H istologic examination revealed large area of mucin and necrosis. In moderate dense septa and parenchyma of tumor, fibrotic hyperpla sia was seen under microscope. Calcification was seen in one case. In arterial phase of dynamic enhanced scanning there was moderate enhancement of the parenchyma and septa. In delayed scanning of four cases, slight enhancement of septa and hon eycomb structure was observed,histologically mucinous matrix and mucimous degeneration were shown. No enlargement of lymph nodes was observed in all cases. There was involvement of superior vena cava in two cases,involvement of left bra chio cephalic vein in two cases. Pericardial effusion was seen in seven cases and pleural effusion in four cases. AFP was markedly elevated in all cases （〉1000ng/ml）. Conclusion：In an adolescent male with large tumor in anterior mediastinum, presenting honeycomb appearance on plain and enhanced CT and delayed enhancement of septa and honeycomb structure, combined with marked elevation of AFP,the diagnosis of PMEST should be considered.

关 键 词：内胚层窦瘤 纵隔 体层摄影术 X线计算机 病理学 

分 类 号：R734.5[医药卫生—肿瘤]