43例小唾液腺癌在多形性腺瘤中的影像学表现  

Imaging findings of carcinoma ex pleomorphic adenoma in minor salivary glands

作　　者：朱文静[1] 余强[1] 陶晓峰[1] 王韶颖[1] 田涛[1] 张春叶[2] ZHU Wen-Jing;YU Qiang;TAO Xiao-feng;WANG Shao-ying;TIAN Tao;ZHANG Chun-ye(Department of Radiology,Shanghai Ninth People's Hospital School of Medicine Shanghai Jiao Tong University,Shanghai 200011,China;Department of Pathology,Shanghai Ninth People's Hospital School of Medicine Shanghai Jiao Tong University,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院放射科,上海200011 [2]上海交通大学医学院附属第九人民医院病理科,上海200011

出　　处：《上海口腔医学》2023年第3期255-260,共6页Shanghai Journal of Stomatology

基　　金：国家自然科学基金(91859202,81771901)。

摘　　要：目的:总结小唾液腺癌在多形性腺瘤中的CT和MRI特征,分析其与病理分型的相关性。方法:收集经手术后病理检查证实的小唾液腺癌在多形性腺瘤中患者43例,分析CT和MRI表现,并将其与病理分型相关联。采用SPSS 25.0软件包中的Fisher确切概率法分析Ⅰ/Ⅱ型和Ⅲ型之间肿瘤形态、边界、内部结构、骨质侵犯和颈淋巴结转移等与病理分型的相关性。结果:83.7%(36/43)的肿瘤边缘呈分叶状;81.4%(35/43)内部出现囊变或坏死,呈现不均匀强化;37.2%(16/43)可见粗钙化或混合钙化灶;25.6%(11/43)出现邻近骨质压迫性吸收。75%(12/16)的Ⅰ/Ⅱ型肿瘤形态规则(圆形或卵圆形),77.8%(21/27)的Ⅲ型肿瘤形态不规则。93.8%(15/16)的Ⅰ/Ⅱ型肿瘤边界清楚,66.7%(18/27)的Ⅲ型肿瘤边界模糊。59.3%(16/27)的Ⅲ型肿瘤出现溶骨性骨质吸收。Ⅰ/Ⅱ型肿瘤平均最大径显著小于Ⅲ型(P<0.05)。Fisher确切概率法分析显示,肿瘤形态、边界、溶骨性骨质吸收3种影像特征与病理分型相关(P<0.001)。结论:大部分小唾液腺癌在多形性腺瘤中的CT和MRI表现以边缘分叶状,不均匀强化为共同特征。Ⅰ/Ⅱ型肿瘤形态多呈圆形或卵圆形、边界清楚,罕见溶骨性骨质破坏;Ⅲ型肿瘤多数形态不规则、边界模糊且易出现溶骨性骨质破坏。将形态、边界和溶骨3种特征相结合,更有助于鉴别Ⅰ/Ⅱ型和Ⅲ型肿瘤。PURPOSE:To summarize the CT and MR imaging features of carcinoma ex pleomorphic adenoma(Ca-ex-PA)in minor salivary gland,and analyze the correlation between various features and pathological classification.METHODS:Forty-three patients with Ca-ex-PA in minor salivary gland were collected.The CT and MRI findings were retrospectively analyzed and correlated with their pathological types.Fisher's exact test was used to analyze the correlation between various imaging features(tumor morphology,boundary,internal structure,bone invasion,cervical lymph node metastasis)and pathological types with SPSS 25.0 software package.RESULTS:Among the 43 patients with Ca-ex-PA,83.7%(36/43)of the tumors were lobulated;81.4%(35/43)showed cystic degeneration or necrosis,with heterogeneous enhancement.Coarse calcification or mixed calcification was found in 37.2%(16/43),25.6%(11/43)had compressive absorption of adjacent bone.75%(12/16)of typeⅠ/Ⅱtumors had regular morphology(round or oval),and 77.8%(21/27)of typeⅢtumors had irregular morphology,93.8%(15/16)of typeⅠ/Ⅱtumors had well-defined margin and 66.7%(18/27)of typeⅢtumors had ill-defined margin.Osteolytic bone resorption occurred in 59.3%(16/27)of typeⅢtumors.The average maximum diameter of typeⅠ/Ⅱtumors was significantly shorter than that of typeⅢ(P<0.05).Fisher's exact test showed the characteristics of tumor morphology,boundary and osteolytic bone resorption were related to pathological grouping(P<0.001).CONCLUSIONS:Most Ca-ex-PA in minor salivary glands is characterized by lobular and heterogeneous enhanced neoplasm on CT and MR imaging.A round or oval tumor with well-defined margin usually correlates with typeⅠandⅡ,contrarily,an irregular mass with ill-defined margin and osteolytic bone destruction usually correlates with typeⅢ.Combining the three characteristics of morphology,boundary and osteolysis is more helpful to distinguish typeⅠ/Ⅱand typeⅢtumors.

关 键 词：癌在多形性腺瘤中 小唾液腺 CT MRI 

分 类 号：R739.8[医药卫生—肿瘤]