成人腹腔内非器官来源囊腺瘤及囊腺癌的多层螺旋CT诊断  

Diagnosis of Intra-abdominal Non-organ-derived Cystadenoma and Cystadenocarcinoma in Adult Patients with Multi-slice Spiral CT

作　　者：邓忠奎 关键[2] 彭洋 肖煦阳 张皓钦 刘明娟[2] DENG Zhongkui;GUAN Jian;PENG Yang;XIAO Xuyang;ZHANG Haoqin;LIU Mingjuan(Department of Radiology,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]广西壮族自治区柳州市中医医院,广西柳州545001 [2]中山大学附属第一医院医学影像科,广东广州510080

出　　处：《中国医学影像学杂志》2018年第7期521-524,530,共5页Chinese Journal of Medical Imaging

基　　金：广东省医学科学技术研究基金项目(A2017008);广东省自然科学基金(2017A030313902)

摘　　要：目的探讨腹腔内非器官来源囊腺瘤(癌)的多层螺旋(MSCT)特点,提高对本病的认识和诊断。资料与方法回顾性分析经手术和病理证实的9例腹腔内非器官来源囊腺瘤(癌)患者,均行术前MSCT平扫加增强扫描、血清肿瘤标志物检查。结合临床症状、实验室检查,分析和总结其MSCT特征。结果 9例患者中,5例血清CA125轻中度升高;2例血清CA19-9轻中度升高,其中1例血清人附睾蛋白升高。MSCT图像病变与腹部器官(肝、胆、胰、阑尾、卵巢)有明确的分界。肿瘤定位腹腔间隙内1例,腹膜后8例。肿物最大径5~15 cm。囊腺瘤5例,包括浆液性囊腺瘤2例、黏液性囊腺瘤1例、浆液性-黏液性混合型囊腺瘤2例,其中4例CT表现为单房囊性肿物,另1例为不规则囊实性肿物;CT动态增强囊性部分均未见强化,囊壁可见轻中度强化。囊腺癌4例,均为浆液性囊腺癌,3例CT表现为囊实性肿物,其中囊内见砂砾样钙化1例;另1例为不规则实性肿物,MSCT增强扫描实性部分明显强化。腹腔内转移2例。结论中年女性腹腔间隙内或腹膜后大的单房囊性或以囊性为主的囊实性肿物,应考虑腹膜原发囊腺瘤或囊腺癌,CT表现具有一定的特征,结合肿瘤标志物有助于术前诊断。Purpose To explore the features of multi-slice spiral CT（MSCT） imaging of intra-abdominal non-organ-derived cystadenoma（cancer）,and to improve the understanding of this type of disease and the diagnosis of MSCT.Materials and MethodsData of nine cases with intra-abdominal non-organ-derived cystadenoma（cancer） confirmed by surgical pathology and treated were retrospectively analyzed.All cases preoperatively received MSCT plain scan plus enhanced scan,and serum tumor marker examination.Combined with clinical symptoms and laboratory tests,their MSCT image features were analyzed and summarized.Results Serum CA125 levels were mildly or moderately elevated in 5 out of 9 patients; mild to moderate increases of serum CA19-9 were observed in 2 patients,among which 1 case of serum human epididymis protein was elevated.There was a clear demarcation between lesions and abdominal organs（liver,gallbladder,pancreas,appendix,and ovary） on MSCT images.One case of tumor was positioned in the abdominal cavity and 8 cases in the retroperitoneum.The largest diameter of the tumor was 5-15 cm.There were 5 cases of cystadenoma（2 cases of serous cystadenoma,1 case of mucinous cystadenoma,and 2 cases of serous-mucous mixed cystadenoma）,of which 4 cases showed singlecavity cystic masses,and another an irregular cystic solid mass.No enhancement in cystic portion was detected under CT dynamic enhancement,and mild or moderate enhancement was seen in the cyst wall.Four cases of cystadenocarcinoma were serous cystadenocarcinomas,with 3 cases displaying solid cystic masses on CT and 1 case grit-like calcification within cyst.Another case was irregular solid mass.MSCT enhanced solid part was obviously enhanced.There was intraperitoneal metastasis in 2 cases.ConclusionThe cystic and solid masses characterized by large single cavity cyst or primarily dominated by cyst developed in the intraperitoneal space or retroperitoneal area in middle-aged women should be considered as peritoneal primary cystadenoma or cystadenocarcinoma.CT

关 键 词：囊腺癌 浆液 囊腺瘤 浆液 囊腺瘤 黏液 体层摄影术 螺旋计算机 腹腔 CA125抗原 CA19-9抗原 诊断 鉴别 

分 类 号：R445.3[医药卫生—影像医学与核医学] R73[医药卫生—诊断学]