子宫内膜间质肉瘤CT、MRI表现
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摘要
目的分析子宫内膜间质肉瘤(ESS)的CT、MRI表现。方法回顾性分析经术后病理证实为ESS的11例患者的CT、MRI资料。11例中,5例接受CT检查,6例接受MR检查,均包括平扫及增强扫描。结果病理结果为低级别ESS 9例,未分化肉瘤2例。11例病灶均为单发,病灶位于宫腔内7例、肌壁间4例,其中类圆形肿块8例、不规则形肿块3例,病灶最大径(9.18±1.36)cm,肿块边界清晰4例、边界不清7例;病灶CT、MRI表现以实性为主4例、呈囊实性6例、以囊性为主1例。CT平扫示5例病灶实性部分密度均近似于或低于子宫肌层,其中4例病灶密度不均,1例密度均匀。MRI平扫示6例病灶ADC图信号均减低,其中5例呈T1WI等或低信号、T2WI高或稍高信号且DWI呈明显高信号,另1例(以囊性为主)呈T1WI稍高信号、T2WI高信号且DWI呈中心高信号。10例增强扫描表现为渐进性、持续性强化,1例以囊性为主的病灶未见强化。8例肿块内可见囊变、坏死,6例肿瘤浸润、破坏子宫深肌层。11例中,伴子宫腺肌症2例、子宫肌瘤5例,合并少量盆腔积液5例、宫腔内积血1例、输卵管积液2例。结论 ESS的CT、MRI表现具有一定特征,可为诊断提供依据。
Objective To observe CT and MRI features of endometrial stromal sarcoma(ESS). Methods Plain and enhanced imaging data, including CT(n=5) and MRI(n=6) of 11 patients with ESS confirmed by postoperative pathology were analyzed retrospectively. Results There were 9 cases of singe low-grade ESS and 2 cases of single undifferentiated sarcoma. The lesions located in the uterine cavity in 7 cases, in the myometrium in 4 cases, manifested as circular masses in 8 cases and as irregular masses in 3 cases. The mean maximum diameter of lesions was(9.18±1.36)cm. The boundaries of lesions were clear in 4 cases and unclear in 7 cases. Based on CT and MRI findings, there were 4 patients with solid masses, 6 patients with solid-cystic masses and 1 case with cystic mass. Solid component of lesions manifested as iso-or hypo-attenuation compared with myometrium on plain CT images in 5 patients, including 4 cases with nonuniform density lesions and 1 case with uniform density lesion. MRI showed signal reducing on ADC images in 6 patients. Among them, lesions in 5 cases manifested as iso-or hypo-signal on T1 WI, hyper-signal or slightly high signal on T2 WI, and slightly high signal on DWI, lesion in another case(cystic mass) manifested as hyper-signal on T1 WI, high signal on T2 WI and high signal in central area of lesion on DWI. Incremental and continuous enhancement were found in 10 cases, while no enhancement was found in the rest one case(cystic mass). Cystic and necrosis changes were found in 8 cases, and invasions of deep layer myometrium were found in 6 cases. Some of the patients had complications, including adenomyosis in 2 cases, uterine fibroid in 5 cases, pelvic effusion in 5 cases, intrauterine hemorrhage in 1 case and salpingian dropsy in 2 cases. Conclusion ESS has characteristic CT and MRI findings, which can provide useful references for diagnosis.
Objective To observe CT and MRI features of endometrial stromal sarcoma(ESS). Methods Plain and enhanced imaging data, including CT(n=5) and MRI(n=6) of 11 patients with ESS confirmed by postoperative pathology were analyzed retrospectively. Results There were 9 cases of singe low-grade ESS and 2 cases of single undifferentiated sarcoma. The lesions located in the uterine cavity in 7 cases, in the myometrium in 4 cases, manifested as circular masses in 8 cases and as irregular masses in 3 cases. The mean maximum diameter of lesions was(9.18±1.36)cm. The boundaries of lesions were clear in 4 cases and unclear in 7 cases. Based on CT and MRI findings, there were 4 patients with solid masses, 6 patients with solid-cystic masses and 1 case with cystic mass. Solid component of lesions manifested as iso-or hypo-attenuation compared with myometrium on plain CT images in 5 patients, including 4 cases with nonuniform density lesions and 1 case with uniform density lesion. MRI showed signal reducing on ADC images in 6 patients. Among them, lesions in 5 cases manifested as iso-or hypo-signal on T1 WI, hyper-signal or slightly high signal on T2 WI, and slightly high signal on DWI, lesion in another case(cystic mass) manifested as hyper-signal on T1 WI, high signal on T2 WI and high signal in central area of lesion on DWI. Incremental and continuous enhancement were found in 10 cases, while no enhancement was found in the rest one case(cystic mass). Cystic and necrosis changes were found in 8 cases, and invasions of deep layer myometrium were found in 6 cases. Some of the patients had complications, including adenomyosis in 2 cases, uterine fibroid in 5 cases, pelvic effusion in 5 cases, intrauterine hemorrhage in 1 case and salpingian dropsy in 2 cases. Conclusion ESS has characteristic CT and MRI findings, which can provide useful references for diagnosis.
引文
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[7] Sandberg AA.The cytogenetics and molecular biology of endometrial stromal sarcoma.Cytogenet Genome Res,2007,118(2-4):182-189.
[8] 王富强,谭改民.子宫外子宫内膜间质肉瘤6例临床病理分析.临床与实验病理学杂志,2017,33(5):565-567.
[9] Rieko F,Masaaki A,Haruyasu Y,et al.Endometrial stromal sarcoma located in the myometrium with a low-intensity rim on T2-weighted images:Report of three cases and literature review.J Magn Reson Imaging,2010,31(4):975-979.
[10] D'Angelo E,Prat J.Uterine sarcomas:A review.Gynecol Oncol,2010,116(1):131-139.
[11] Ueda M,Otsuka M,Hatakenaka M,et al.MR imaging findings of uterine endometrial stromal sarcoma:Differentiation from endometrial carcinoma.Eur Radiol,2001,11(1):28-33.
[12] Wu TI,Yen TC,Lai CH.Clinical presentation and diagnosis of uterine sarcoma,including imaging.Best Pract Res Clin Obstet Gynaecol,2011,25(6):681-689.
[13] 刘英琦,张静.囊性低级别子宫内膜间质肉瘤一例.磁共振成像,2016,7(9):699-701.
[14] Mateo PH,Fernández RM,Tamayo ES.Uterine sarcoma vs adenocarcinoma:Can the MRI distinguish between them?Radiología,2016,58(3):199-206.
[2] He L,Li JD,Xiong Y,et al.Clinicopathological and molecular markers associated with prognosis and treatment effectiveness of endometrial stromal sarcoma:A retrospective study in China.Arch Gynecol Obstet,2014,289(2):383-391.
[3] 蔡琪,张浩,任芸芸.子宫内膜间质肉瘤(ESS)的临床和病理特点及超声结果.复旦学报(医学版),2018,45(6):835-839,845.
[4] Koh WJ,Aburustum NR,Bean S,et al.Uterine neoplasms,version 1.2018,NCCN clinical practice guidelines in oncology.J Natl Compr Canc Netw,2018,16(2):170-199.
[5] Conklin CM,Longacre TA.Endometrial stromal tumors:The new WHO classification.Adv Anat Pathol,2014,21(6):383-393.
[6] 邓波儿,孔为民.子宫内膜间质肉瘤的研究进展.临床肿瘤学杂志,2017,22(11):1048-1051.
[7] Sandberg AA.The cytogenetics and molecular biology of endometrial stromal sarcoma.Cytogenet Genome Res,2007,118(2-4):182-189.
[8] 王富强,谭改民.子宫外子宫内膜间质肉瘤6例临床病理分析.临床与实验病理学杂志,2017,33(5):565-567.
[9] Rieko F,Masaaki A,Haruyasu Y,et al.Endometrial stromal sarcoma located in the myometrium with a low-intensity rim on T2-weighted images:Report of three cases and literature review.J Magn Reson Imaging,2010,31(4):975-979.
[10] D'Angelo E,Prat J.Uterine sarcomas:A review.Gynecol Oncol,2010,116(1):131-139.
[11] Ueda M,Otsuka M,Hatakenaka M,et al.MR imaging findings of uterine endometrial stromal sarcoma:Differentiation from endometrial carcinoma.Eur Radiol,2001,11(1):28-33.
[12] Wu TI,Yen TC,Lai CH.Clinical presentation and diagnosis of uterine sarcoma,including imaging.Best Pract Res Clin Obstet Gynaecol,2011,25(6):681-689.
[13] 刘英琦,张静.囊性低级别子宫内膜间质肉瘤一例.磁共振成像,2016,7(9):699-701.
[14] Mateo PH,Fernández RM,Tamayo ES.Uterine sarcoma vs adenocarcinoma:Can the MRI distinguish between them?Radiología,2016,58(3):199-206.