原发性纵隔精原细胞瘤影像学表现与病理学基础  

Imaging Features and Pathological Basis of Primary Mediastinal Seminoma

作　　者：梁锐烘 曾庆思[2] 刘琴[2] 许乙凯[1] 冯婕[1] LIANG Ruihong;ZENG Qingsi;LIU Qin(Medical Imaging Center,Nanfang Hospital of Southern Medical University,Guangzhou,Guangdong Province 510515,P.R.China)

机构地区：[1]南方医科大学南方医院影像中心,广州510515 [2]广州医科大学附属第一医院放射科,广州510120

出　　处：《临床放射学杂志》2021年第6期1111-1115,共5页Journal of Clinical Radiology

摘　　要：目的探讨原发性纵隔精原细胞瘤(PMSGCT)的CT、PET-CT表现及其病理学基础。方法回顾性分析经病理确诊的11例PMSGCT患者的影像学表现,并与其病理结果对照,11例均接受胸部CT增强及平扫检查,3例同期接受^(18)F-FDG PET-CT检查。结果11例患者均为青少年男性,病灶CT表现为不规则分叶状肿块10例,卵圆形状1例;右前纵隔7例,左前纵隔3例,左前纵隔-颈根部1例;最大径4.70~15.30 cm,平均(10.77±3.75)cm,其中6例最大直径≥10.00 cm。5例密度均匀一致,无坏死;4例伴少许斑片局灶性坏死;2例大部分为实性成分,内多发斑片、条片坏死。增强两期扫描11例均渐进性强化,中度强化7例,明显强化2例,轻度强化2例。11例侵犯周围脂肪间隙,其中累及两侧头臂静脉和/或上腔静脉综合征3例,胸腺1例,心包及左肺静脉1例,气管及食管上段、主动脉弓1例,左侧锁骨上淋巴结转移1例,心包及胸腔积液各1例,3例病灶放射性摄取均明显增高。治疗后5例完全缓解,5例病情稳定,1例术后复发。结果PMSGCT好发于青少年男性,其CT主要表现为前纵隔密度均匀一致的不规则实性肿块或局部伴少许灶性坏死,常侵犯周围脏器及血管,可有淋巴结及远处转移,增强扫描多为中度渐进性强化;病灶^(18)F-FDG摄取呈高代谢。Objective To investigate the CT and PET-CT findings and pathological basis of primary mediastinal seminoma(PMSGCT).Methods The imaging findings of 11 patients with PMSGCT confirmed by pathology were retrospectively analyzed and compared with the pathological results.All 11 cases underwent chest CT plain and enhancedscan,and 3 cases underwent ^(18)F-DG PET-CT examination at the same time.Results All the 11 patients were young men.The CT manifestations of the lesions were irregular lobulated masses in 10 cases and oval shape in 1 case;right anterior mediastinum in 7 cases,left anterior mediastinum in 3 cases,left anterior mediastinum in 1 case;the maximum diameter was 4.70~15.30 cm,with an average of(10.77±3.75)cm,of which 6 cases had the maximum diameter≥10.00 cm.5 cases had uniform density without necrosis;4 cases had focal necrosis with a few patches;2 cases were mostly solid components with multiple patch and strip necrosis.On two-phasecontrast-enhanced scan,11 cases showed progressive enhancement,7 cases showed moderate enhancement,2 cases showed obvious enhancement,and 2 cases showed slight enhancement.11 cases involved peripheral fat space,including 3 cases of brachiocephalic vein and/or superior vena cava syndrome,1 case of thymus,1 case of pericardium and left pulmonary vein,1 case of trachea,upper esophagus and aortic arch.One case was left supraclavicular lymph node metastasis.Pericardial effusion and pleural effusion were found in 1 case.The uptake of radioactivity was significantly increased in 3 cases.After treatment,5 cases were completely relieved,5 cases were stable,and 1 case recurred.Conclusion PMSGCT usually occurs in young men.The main CT manifestations of pmsgct are irregular solid mass with uniform density in the anterior mediastinum or with a little focal necrosis,which often invades the surrounding organs and vessels,and may have lymph node and distant metastasis.The enhanced scan mostly shows moderate progressive enhancement;the uptake of ^(18)F-FDG in the lesions is hypermetabolism.

关 键 词：纵隔肿瘤 原发性精原细胞瘤 体层摄影术 X线计算机 正电子发射断层显像术 

分 类 号：R737.21[医药卫生—肿瘤] R730.44[医药卫生—临床医学]