儿童松果体区肿瘤的临床及影像学特征  

The clinical and imaging characteristics of pineal region tumors in children

作　　者：梅鑫[1] 李玉华[1] 刘明[1] 郑慧[1] 曹雯君[1] 夏正荣[1] 

机构地区：[1]上海交通大学医学院附属新华医院放射科,上海200082

出　　处：《放射学实践》2017年第6期608-614,共7页Radiologic Practice

摘　　要：目的:探讨儿童松果体区肿瘤的临床及影像学特征,旨在提高术前诊断水平。方法:回顾性分析手术病理证实的42例儿童松果体区肿瘤临床资料(性别、年龄、主要临床症状、肿瘤指标)及影像学表现。结果:42例中,生殖细胞源性肿瘤25例(混合性生殖细胞瘤11例、畸胎瘤11例、生殖细胞瘤3例),男性占92%,平均年龄为(7.6±3.3)岁。9例有甲胎蛋白(AFP)升高,人绒毛膜促性腺激素(HCG)升高6例;松果体母细胞瘤12例,其中1例合并双侧视网膜母细胞瘤,平均年龄(2.7±1.9)岁;毛细胞型星形细胞瘤5例,平均年龄(6.4±2.7)岁。临床表现以颅内高压引起的头痛、恶心、呕吐为主(69%),少数表现为视力障碍、性早熟。不少肿瘤的CT和MR表现有一定相似之处,但有些肿瘤还是具有一定特征。结论:儿童松果体区肿瘤以生殖细胞肿瘤多见,其中以混合性生殖细胞瘤、畸胎瘤多见,影像学表现结合生化指标对肿瘤的定性非常重要。松果体母细胞瘤发病率也较高,影像表现与生殖细胞瘤非常相似,年龄较小是鉴别要点。Objective：To explore the characteristics of clinical data and imaging findings of pineal region tumors in children, and to improve the accuracy of preoperative diagnosis. Methods ： The clinical data （gender, age, main clinical mani- festations and tumor markers） and imaging features of 42 children with pineal region tumors confirmed by pathology were analyzed retrospectively. Results： Among these 42 cases,there were 25 cases of germ cell tumors including 11 cases of mixed germ cell tumors,ll cases of teratoma and 3 cases of germinoma. 92% were male with the average age 7.6±3.3 years. A high serum level of alpha-fetoprotein （AFP） was presented in 9 cases and incrased human chorionic gonadotropin （HCG） in 6 cases. There were 12 cases of pineoblastoma with the average age 2.7±1.9 years,one of 12 cases was complicated with bilateral retinoblastoma. 5 cases of pilocytic astrocytoma were proved with the average age 6.4±2.7 years. The most com- mon symptoms included headaches and nausea and vomiting caused by increased intracranial pressure （69%）,and a few cases tended to have visual impairment and sexual precocity. There were some CT and MR imaging features in common; however,certain specific features were found in some tumors. Conclusion：Germ celi tumors occur most frequently in the pineal region in children especially the mixed germ cell tumors and teratoma. It is of great importance for diagnosis to combine the imaging findings with tumor markers. The incidence of pineoblastoma is also high and the imaging findings can be very similar to that of germinoma. One of the distinguishing features is that pineoblastoma usually involves younger children.

关 键 词：松果体瘤 磁共振成像 体层摄影术 X线计算机 儿童 

分 类 号：R445.2[医药卫生—影像医学与核医学] R730.44[医药卫生—诊断学] R739.41[医药卫生—临床医学]