儿童常见睾丸生殖细胞肿瘤的超声表现和临床特征  

Ultrasonographic and clinical features of common testicular germ cell tumors in children

作　　者：胡慧勇[1] 许云峰[1] 陈亚青[2] 蒋珺 王海荣[1] 蒋海燕[1] 耿天笑 侯艳青 HU Hui-yong;XU Yun-feng;CHEN Ya-qing;JIANG Jun;WANG Hai-rong;JIANG Hai-yan;GENG Tian-xiao;HOU Yan-qing(Department of Ultrasound,Shanghai Children's Hospital,Shxinghai Jiao Tong University,Shanghai 20QQ62,China;Department of Ultrasound,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海市儿童医院/上海交通大学附属儿童医院超声科,上海200062 [2]上海交通大学医学院附属新华医院超声科,上海200092

出　　处：《中华男科学杂志》2020年第2期143-148,共6页National Journal of Andrology

摘　　要：目的:探讨儿童常见睾丸生殖细胞肿瘤(TGCT)的超声表现和临床特征. 方法:回顾性分析2013年3月至2019年1月92例儿童TGCT的实验室检查、超声检查和临床资料,并采用受试者工作曲线(ROC)分析血清AFP值和肿瘤最大直径对肿瘤良恶性的诊断效能. 结果:畸胎瘤是儿童最常见的睾丸肿瘤,超声提示畸胎瘤多为囊实混合性(25/40,62.5%)或实性肿块(12/40,32.5%);表皮样囊肿可见典型的“洋葱圈”征(6/18,33.3%)和包膜钙化征(4/18,22.2%);卵黄囊瘤(YST)多表现为等回声(11/26,42.3%)或低回声(8/26,30.9%)实性肿块,肿瘤均不伴钙化,部分YST(7/26,26.9%)肿瘤内部见囊性无回声.彩色多普勒血流显像大部分YST血流信号丰富(25/26,96.2%),所有表皮样囊肿和皮样囊肿内部均未见血流信号.采用ROC曲线分析显示,血清AFP值ROC曲线下面积为0.985,最佳截断值为124.2 ng/ml,AFP诊断良恶性肿瘤的敏感性、特异性分别为92.9%、93.7%;肿瘤最大直径ROC曲线下面积为0.796,最佳截断值为2.7cm,肿瘤最大直径诊断良恶性肿瘤的敏感性、特异性分别为57.1%、93.7%. 结论:不同病理类型儿童TGCT超声声像图有一定的特征性表现,儿童TGCT预后良好,当血清AFP≥124.2 ng/ml、肿瘤最大直径≥2.7 cm时应考虑根治性睾丸切除术.Objective:To study the ultrasonographic manifestations and clin ical features o f common pediatric testicular germ cell tumors(TGCT)in children.Methods:We retrospectively analyzed the laboratory,ultrasonographic and clinical data on 92 children with TGCT diagnosed in Shanghai Childrens Hospital from March 2013 to January 2019,and investigated the values of the serum alpha-fetoprotein(AFP)level and maximum diameter of tumors in the diagnosis of benign and malignant tumors using the ROC curve.:Of the 92 cases of pediatric TGCT,64(69.6%)were pathologically confirmed as benign tum ors,including 40 cases of teratoma(62.5%),18 cases of epiderm oid cyst(28.1%)and 6 cases of dermoid cyst(9.4%),and the other 28(30.4%)as m alignant neoplasms,including 26 cases of yolk sac tumor(YST,92.9%)and 2 cases of mixed germ cell tumor(MGCT,7.1%).Ultrasonography showed that 62.5%of the teratomas were cystic-solid mixed(25/40)and 32.5%solid masses(12/40),that 33.3% of the epidermoid cysts exhibited a typical sign of"onion ring"(6/18)and 22.2%that of capsular calcification(4/18),and that 42.3%o f the YSTs displayed isoechoic(11/26),30.9%hypoechoic(8/26)solid masses without calcium and 26.9%cystic anechoic lesions(7/26).Color Doppler blood flow imaging manifested abundant blood flow signals in most of the YSTs(25/26,96.2%)but none in either the epidermoid or the dermoid cysts.The area under the ROC curve(AUC)of the serum AFP value was 0.985,with an optimal cutoff value of 124.2 n g/ml,and the sensitivity and specificity of AFP in the diagnosis of benign and malignant tumors were 92.9%and 93.7%,respectively.The AUC of the maximum diameter of the tumors was 0.796,with an optimal cutoff value of 2.7cm,and the sensitivity and specificity of the maximum diameter of the tumors in the diagnosis of benign and malignant neoplasms were 57.1%and 93.7%,respectively.Conclusion:Ultrasonographic images have different characteristic manifestations for different pathological types of pediatric TGCT.Pediatric TGCT has a good prognosis and radical orchiect

关 键 词：睾丸生殖细胞肿瘤 甲胎蛋白 肿瘤直径 超声 临床特征 儿童 

分 类 号：R737.21[医药卫生—肿瘤]