腹膜后平滑肌肉瘤:多排螺旋CT动态增强表现及其病理基础  

Correlation of dynamic MDCT findings with pathological diagnosis of retroperitoneal leiomyosarcoma

作　　者：晏耀文[1] 周建军[2] 章力[3] 胡少波[1] 

机构地区：[1]新昌县人民医院放射科,浙江绍兴312500 [2]复旦大学附属中山医院放射科上海市影像医学研究所,上海200032 [3]新昌县人民医院病理科,浙江绍兴312500

出　　处：《实用肿瘤杂志》2015年第6期543-546,共4页Journal of Practical Oncology

摘　　要：目的分析腹膜后平滑肌肉瘤的CT表现及其与病理的关系,以提高诊断准确性。方法回顾性分析经手术病理证实的腹膜后平滑肌肉瘤9例,术前经多排螺旋CT平扫和动态增强扫描,复习CT扫描结果并和手术病理进行对照分析。结果 9例腹膜后平滑肌肉瘤中,肿瘤呈椭圆形7例,不规则形2例;5例边缘毛糙,4例边缘较光整;肿瘤直径4.7-14.6 cm,平均8.3 cm。肿瘤平扫密度不均匀,9例均见片状低密度坏死区,范围大小不一,3例可见钙化。动态增强肿瘤实质成分呈进行性持续强化,强化较明显,坏死区无强化,4例瘤内可见血管影,肿瘤血管形态欠规则,1例肿瘤周围可见丰富滋养血管,2例肿瘤与髂总动脉境界不清。镜下肿瘤细胞丰富,呈梭形,细胞明显异型,可见凝固性坏死灶,核分裂数约12-16个/10 HPF。免疫组织化学结果为SMA（＋）、Des（＋）、Vim（＋）、EMA（-）或少量阳性、CEA（-）。结论腹膜后平滑肌肉瘤的CT表现具有一定的特征性,CT对其诊断具有较大价值。Objective To investigate the relationship of CT findings with pathological results of retroperitoneal leiomyosarcoma. Methods Nine patients with retroperitoneal leiomyosarcoma confirmed by surgical pathology underwent plain scanning and dynamic contrast-enhanced scanning with multi-detector spiral CT（ MDCT） before operation. The correlation of CT scan and pathological findings was analyzed. Results Plain CT scanning showed that the tumor presented oval shape in 7 cases and irregular shape in 2; with rough edges in 5 cases and smooth edges in 4. The average diameter of tumors was 8. 3 cm（ 4. 7 - 14. 6 cm）. The density of tumors was uneven. Patchy low density necrosis areas were observed in all 9 cases with various sizes and calcification was found in 3 cases. Dynamic CT scanning showed that the parenchyma of tumors presented progressive enhancement and there was no enhancement in necrosis areas. Vascular image was found in4 cases and with affluent blood vessels in 1 case; the tumors were obscured by common iliac artery in 2 cases. Pathological examination demonstrated ample spindle-shaped tumor cells with significant heteromorphism. The coagulative necrosis foci were observed,and the number of nuclear division was 12 - 16 /10 HPF. Immunohistochemistry revealed SMA（ ＋）,Des（ ＋）,Vim（ ＋）,EMA（ ＋ /-） and CEA（-） in tumor cells. Conclusion Retroperitoneal leiomyosarcoma presents characteristic features on plain and contrast-enhanced CT scans,which may be of value in preoperative diagnosis.

关 键 词：腹膜后肿瘤/放射摄影术 平滑肌肉瘤/放射摄影术 腹膜后肿瘤/病理学 平滑肌肉瘤/病理学 体层摄影术 螺旋计算机 

分 类 号：R735.4[医药卫生—肿瘤] R730.44[医药卫生—临床医学]