子宫内膜样腺癌病理表现与MRI影像对照分析
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摘要
目的探析子宫内膜样腺癌病理表现并与MRI影像表现进行对照。方法选择我院2011年4月-2015年12月期间收治16例子宫内膜样腺癌患者为例,均行MRI检查。总结患者手术与病理表现及MRI影像表现特点。结果病理表现:外观均呈不规则团块状肿物,12例为囊实性、4例为实性。8例单纯型、6例复合型、2例混合型。镜下肿瘤细胞呈现柱状,腺样或乳头状排列,核大深染,分裂象较为常见。MRI表现:病灶均存在占位效应,膀胱、子宫、周围肠管等脏器受压移位,均伴腹水。12例边界清晰、4例模糊。部分可见多发纡曲血管、壁结节、囊液呈T1WI均匀等或高信号、子宫内膜增厚。肿块直径在3.7-16.3cm。MRI平扫结果示囊实性肿块13例、实性肿块3例;增强扫描结果示13例实性部分呈斑片状明显强化,3例轻、中度强化。结论子宫内膜样腺癌的MRI表现有一定特征性,平扫以囊实性肿块多见,边界多清晰、可见腹水、占位效应明显,部分可见壁结节、子宫内膜增厚,增强扫描实性部分多呈斑片状明显强化,对子宫内膜样腺癌的定位、定性及鉴别诊断具有较大价值,确诊有赖病理检查。
Objective To explore the pathological manifestations of endometrial adenocarcinoma and to compare them with MRI findings. Methods 16 cases of patients with endometrial adenocarcinoma who were admitted in our hospital between April 2011 and December 2015 were included in the study all of whom were examined by MRI. Surgical and pathological manifestations and MRI findings were summarized. Results The pathological manifestations showed that there were irregular lumpy masses, 12 cases cystic and 4 cases solid. 8 cases were simple type, 6 cases of compound type and 2 cases of mixed type. Under the microscope, the tumor cells showed columnar, adenoid or papillary arrangement, with large nuclear deeply stained and mitotic figure was common. MRI findings: there was space occupying effect in all lesions. Bladder, uterus, peripheral intestine and other organs were pressed and shifted, with ascites. 12 cases were with clear boundaries and 4 cases with fuzzy ones. There were multiple tortuous blood vessels and wall nodules. Cystic fluid showed homogeneous equal or high signal on T1WI and endometrium thickened. The diameter of masses was 3.7-16.3 cm. MRI plain scan showed 13 cases of cystic solid mass and 3 cases of solid mass. Enhanced scan showed that 13 cases of solid parts were with patchy significant enhancement, 3 cases with mild and moderate enhancement. Conclusion MRI findings of endometrial adenocarcinoma have certain characteristics, and cystic and solid masses are common. Boundaries are clear and ascites and mass effect are obvious. There are wall nodules and endometrial thickening. After enhanced scan, the solid parts shows patchy significant enhancement, which is of great value in localization qualitation and differential diagnosis of endometrioid adenocarcinoma. Its diagnosis depends on pathological examination.
Objective To explore the pathological manifestations of endometrial adenocarcinoma and to compare them with MRI findings. Methods 16 cases of patients with endometrial adenocarcinoma who were admitted in our hospital between April 2011 and December 2015 were included in the study all of whom were examined by MRI. Surgical and pathological manifestations and MRI findings were summarized. Results The pathological manifestations showed that there were irregular lumpy masses, 12 cases cystic and 4 cases solid. 8 cases were simple type, 6 cases of compound type and 2 cases of mixed type. Under the microscope, the tumor cells showed columnar, adenoid or papillary arrangement, with large nuclear deeply stained and mitotic figure was common. MRI findings: there was space occupying effect in all lesions. Bladder, uterus, peripheral intestine and other organs were pressed and shifted, with ascites. 12 cases were with clear boundaries and 4 cases with fuzzy ones. There were multiple tortuous blood vessels and wall nodules. Cystic fluid showed homogeneous equal or high signal on T1WI and endometrium thickened. The diameter of masses was 3.7-16.3 cm. MRI plain scan showed 13 cases of cystic solid mass and 3 cases of solid mass. Enhanced scan showed that 13 cases of solid parts were with patchy significant enhancement, 3 cases with mild and moderate enhancement. Conclusion MRI findings of endometrial adenocarcinoma have certain characteristics, and cystic and solid masses are common. Boundaries are clear and ascites and mass effect are obvious. There are wall nodules and endometrial thickening. After enhanced scan, the solid parts shows patchy significant enhancement, which is of great value in localization qualitation and differential diagnosis of endometrioid adenocarcinoma. Its diagnosis depends on pathological examination.
引文
[1]吕晓玉,吕涛,郝轶等.彩色多普勒超声对卵巢子宫内膜样腺癌的诊断价值[J].广东医学,2014,24(17):2691-2693.
[2]吴琼蔚,谢晖亮,马成斌,等.术中快速冰冻病理检查诊断子宫内膜癌的价值探讨[J].实用妇产科杂志,2012,28(6):460-463.
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[8]曾茗,张海燕,宋鹏,等.子宫内膜癌的CT与MRI诊断价值研究[J].中国CT和MRI杂志,2015,13(9):93-95.
[9]廖瑜,黎清,李依芬,等.子宫内膜癌临床及M R I分期与手术病理分期的对比研究[J].广东医学,2012,33(4):472-473.
[10]张晓娜,苏晓明,温义成,等.MRI扩散加权成像术前评估子宫内膜癌肌层浸润深度的价值[J].中国老年学杂志,2012,32(10):2028-2029.
[11]田兆华,王志启,黄强,等.子宫内膜样腺癌伴鳞状上皮分化46例临床病理特征及预后分析[J].实用妇产科杂志,2012,28(2):102-104.
[12]饶金,叶倩,张江宇,等.宫颈与宫体子宫内膜样腺癌的临床病理及免疫表型分析[J].临床与实验病理学杂志,2012,28(7):780-783.
[13]徐德,付劲锋,林博宁,等.一级子宫内膜样腺癌累及腺肌病临床病理分析[J].临床与实验病理学杂志,2010,26(5):622-624.
[2]吴琼蔚,谢晖亮,马成斌,等.术中快速冰冻病理检查诊断子宫内膜癌的价值探讨[J].实用妇产科杂志,2012,28(6):460-463.
[3]单波儿,任玉兰,孙建民,等.年轻早期高分化子宫内膜样腺癌或子宫内膜不典型增生保留生育功能的Ⅱ期临床研究[J].中国癌症杂志,2012,22(6):424-429.
[4]刘婷婷,孔为民.子宫内膜浆液性腺癌51例临床病理分析[J].中国临床医生杂志,2015,4(9):74-77.
[5]刘苏,谷丽萍,蔡明哲,等.子宫内膜癌455例临床病例分析[J].中国妇幼保健,2012,27(3):348-349.
[6]李兰.子宫内膜上皮内瘤变的临床病理分析[J].中国实验方剂学杂志,2011,17(9):256-258.
[7]徐基成,余绍兰,李晓琼,等.子宫内膜癌19例临床病理分析[J].实用医院临床杂志,2012,09(5):139-142.
[8]曾茗,张海燕,宋鹏,等.子宫内膜癌的CT与MRI诊断价值研究[J].中国CT和MRI杂志,2015,13(9):93-95.
[9]廖瑜,黎清,李依芬,等.子宫内膜癌临床及M R I分期与手术病理分期的对比研究[J].广东医学,2012,33(4):472-473.
[10]张晓娜,苏晓明,温义成,等.MRI扩散加权成像术前评估子宫内膜癌肌层浸润深度的价值[J].中国老年学杂志,2012,32(10):2028-2029.
[11]田兆华,王志启,黄强,等.子宫内膜样腺癌伴鳞状上皮分化46例临床病理特征及预后分析[J].实用妇产科杂志,2012,28(2):102-104.
[12]饶金,叶倩,张江宇,等.宫颈与宫体子宫内膜样腺癌的临床病理及免疫表型分析[J].临床与实验病理学杂志,2012,28(7):780-783.
[13]徐德,付劲锋,林博宁,等.一级子宫内膜样腺癌累及腺肌病临床病理分析[J].临床与实验病理学杂志,2010,26(5):622-624.