原发性腹膜后平滑肌肉瘤的影像表现  

Imaging features of primary retroperitoneal leiomyosarcoma

作　　者：张琰琰 王亚丽 王翠薇 袁涛 叶新华 张丁哲 ZHANG Yanyan;WANG Yali;WANG Cuiwei;YUAN Tao;YE Xinhua;ZHANG Dingzhe(Department of Ultrasound Diagnosis, Jiangsu People's Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R.China;Department of Radiology, Jiangsu Hospital of Traditional Chinese Medicine, Nanjing 210029, P.R.China)

机构地区：[1]南京医科大学第一附属医院江苏省人民医院超声诊断科,江苏南京210029 [2]江苏省中医院放射科,江苏南京210029

出　　处：《医学影像学杂志》2021年第8期1372-1375,共4页Journal of Medical Imaging

摘　　要：目的探讨原发性腹膜后平滑肌肉瘤(primary retroperitoneal leiomyosarcoma,PRLS)的影像表现及临床病理学特点。方法选取32例经手术病理证实的PRLS的影像(超声、CT及MRI)表现及临床资料,分析总结其特征性表现。结果肿瘤最大径为1.8~19.0 cm,肿瘤体积较小时,多呈椭圆形,体积较大时,形态不规则。2例行常规超声检查,呈实性为主的低回声,30例行CT平扫加增强检查,平扫呈软组织密度,大部分病灶内见低密度坏死区,均未见钙化;增强扫描实性部分动脉期多呈高增强,静脉期持续强化。10例行MRI平扫加增强扫描,实性部分T1WI呈等或低信号、T2WI呈等或稍高信号,DWI呈高信号,强化方式与CT相似。28例行免疫组织化学检查:SMA阳性率100%,Desmin阳性率71.4%(20/28),H-caldesmon阳性率28.6%(8/28),CD34阳性率10.7%(3/28),S-100阳性率3.6%(1/28),CD117(-)阴性率100%(28/28)。结论腹膜后平滑肌肉瘤的影像表现具有一定的特征性,对该肿瘤的术前诊断和鉴别诊断具有一定的临床意义。Objective To investigate the imaging and clinico-pathological features of primary retroperitioneal leiomyosarcoma.Methods The imaging(US,CT and MR)findings and clinical data of 32 retroperitoneal leiomyosarcoma confirmed by surgery or pathology were retrospectively analyzed.Results The maximum diameter of the tumor was 1.80 to 19.0 cm.The shape of the tumor may be oval or irregular depending on the volume of the tumor.Two cases appeared as oval solid hypoechoic tumor in routine ultrasound examination.Thirty cases udergoing routine and enhanced CT scanning were predominantly solid but often contained necrotic spaces.Calcifications were rarely seen.The masses often showed high enhancement in the arterial phase and continuous enhancement in the portal venous phase.The solid components of the tumors demonstrated hypointense or isointense signal intensity onn T1WI,high signal intensity on T2WI and DWI,with the enhancement pattern similar to that of CT imaging.Immunohistochemistry results were as follows the positive rate of SMA was 100%,Desmin was 71.4%(20/28),H-Caldesmon was 28.6%(8/28),CD34 was 10.7%(3/28),and 100 was 3.6%(1/28).All cases demonstrated CD117 negative.ConclusionThe imaging manifestations of retroperitoneal leiomyosarcoma demonstrate certain characteristics,which play an important role in the diagnosis and differential diagnosis of this tumor.

关 键 词：腹膜后 平滑肌肉瘤 超声诊断 体层摄影术 X线计算机 磁共振成像 

分 类 号：R735.4[医药卫生—肿瘤] R445.1[医药卫生—临床医学]