乳腺佩吉特病影像学表现与病理对照  

Comparison on imaging and pathology findings of mammary Paget disease

作　　者：朱婷婷[1,2] 史军华 汤子建[1] 冉春艳[1] 张体江 ZHU Tingting;SHI Junhua;TANG Zijian;RAN Chunyan;ZHANG Tijiang(Department of Radiology,Affiliated Hospital of Zunyi Medical College,Zunyi 563003,China;Department of Radiology,People’s Hospital of Honghuagang District,Zunyi 563003,China)

机构地区：[1]遵义医学院附属医院影像科,贵州遵义563003 [2]遵义市红花岗区人民医院影像科,贵州遵义563003

出　　处：《中国医学影像技术》2018年第8期1216-1219,共4页Chinese Journal of Medical Imaging Technology

基　　金：贵州省国际科技合作计划项目[黔科合外G字(2013)7038号]

摘　　要：目的分析乳腺佩吉特病(MPD)钼靶X线乳腺摄影(MTM)及MRI表现,并与病理结果对照。方法回顾性分析我院经病理证实的22例MPD的MTM及MRI表现,并与病理结果对照。结果 MTM发现22例乳腺实质内异常,14例伴乳头、乳晕区异常。3例单纯MPD均呈粗大钙化,其中2例钙化位于乳头乳晕。8例MPD伴导管原位癌(DCIS)表现为单纯区域性或段样分布的细小多形性、粗糙不均质钙化;9例MPD伴浸润性导管癌(IDC)表现为肿块或局限性致密影伴区域性或线样分布的多形性、粗糙不均质及线样钙化;2例MPD伴微浸润癌表现为肿块或局灶性致密影伴多形性、粗糙不均质的线样或段样钙化。6例接受MR扫描,表现为乳头、乳晕区不对称性异常强化区,时间-信号曲线3例呈速升-平台型、3例呈廓清型;MPD伴DCIS表现为段样分布不均匀强化,MPD伴IDC表现为区域性分布集簇状强化。结论重视乳头乳晕区观察对正确诊断MPD至关重要;分析MTM钙化形态、分布特征和MRI特点有助于诊断MPD。Objective To analyze the characteristics of mammary Paget disease（MPD）on molybdenum targets mammography（MTM）and MRI compared with pathological findings.Methods MTM and MRI features of 22 patients with histopathologically proved MPD were retrospectively analyzed compared with pathological findings.Results MTM showed mammary parenchyma abnormalities in all 22 patients,among them 14 with nipple areola area abnormalities.Coarse calcification was observed in all 3 simple MPD patients,located in nipple areola area in 2 patients.In 8 patients of MPD complicated with ductal carcinoma in situ（DCIS）,pure regional/segmental distribution of fine pleomorphic/coarse heterogeneous calcifications was detected.In 9 patients of MPD complicated with invasive ductal carcinoma（IDC）,palpable masses or focal asymmetrical density and regional/linear distribution of pleomorphic/coarse heterogeneous/fine linear calcifications were noticed.Mass or asymmetrical density and pleomorphic/coarse heterogeneous/fine linear and segmental calcifications were observed in 2 MPD patients complicated with micro-invasive carcinoma. Asymmetric abnormal enhancement of nipple areolar area was detected on MRI,with platform type（n=3）or outflow type（n=3）of time-signal intensity curves on dynamic enhanced MRI.Segmental heterogenous enhancement was found when MPD complicated with DCIS,while regional clumped non-mass like enhancement was observed when MPD complicated with IDC.ConclusionObservation of nipple and areola is critical to make correct diagnosis of MPD.Analysis of the morphology and distribution features of calcifications and MRI characteristics is helpful to diagnosis of MPD.

关 键 词：佩吉特病 乳腺 乳腺肿瘤 乳房X线摄影术 磁共振成像 

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] R737.9[医药卫生—临床医学]