血管黏液瘤的影像学表现与病理学对照分析
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摘要
目的探讨侵袭性血管黏液瘤(AAM)及表浅性血管黏液瘤(SA)的影像学表现特征,以提高对本病的认识。方法回顾性分析本院经手术、病理证实的AAM 11例和SA 3例影像学资料完整的患者,男性4例,女性10例,年龄22～58岁,中位年龄28岁。其中1例PETCT,4例CT,5例US,8例MRI,分析AAM及SA的临床特点及影像学表现。结果4例位于盆腔,4例位于上腹部,1例外阴皮下,1例阴道,1例肝脏,1例耳朵,1例阴囊内,1例腋窝。8例接受MRI检查,与肌肉相比,病灶T_2WI高信号6例,混杂信号2例;T_1WI低信号7例,等信号1例;8例均接受增强检查,2例表现渐进性强化,1例轻度强化,5例不均匀性明显强化,5例出现典型的旋涡状或分层样改变。4例接受CT平扫与增强扫描,与肌肉相比,3例平扫呈低密度,1例平扫等密度,2例不均匀性强化,2例未见明显强化;5例行超声检查,2例为实性偏低回声区;3例为不均质混合性回声区;1例~(18)F-FDG-PETCT示低浓聚。结论血管黏液瘤多发生于中青年女性盆腔,超声为低或混合性回声;CT增强不均匀性逐渐强化;MR同CT一样,病灶表现逐渐强化,但能特征性的显示分层或漩涡征,PETCT为低摄取,这些特点均有助于该病的正确诊断。
Objective To investigate the imaging features of invasive angio-myxoma(AAM) and superficial angio-myxoma(SA) to improve the understanding of this disease. Methods We retrospectively analyzed of 11 cases of pathologically confirmed AAM and SA 3 cases of complete imaging data. There were 4 males and 10 females, aged 22～58 years, with mean age of 28 years old, including 1 case of PETCT, 4 cases of CT, 5 cases of US, 8 cases of MRI, the clinical features and imaging findings of AAM and SA. Results Four cases were located in the pelvis, four cases were located in the upper abdomen, one case was vulvar subcutaneous, one case was vaginal, one case was liver, one case was ear, one case was scrotal and one case was axillary. 8 cases underwent MRI examination. Compared with the muscle, the lesions showed high T_2WI signal in 6 cases, mixed signal in 2 cases, T_1WI low signal in 7 cases and equal signal in 1 case. All 8 cases underwent enhanced examination, 2 cases showed progressive enhancement, 1 case mild enhancement, 5 cases of non-uniformity was significantly enhanced, 5 cases of typical whirlpool-like or stratified changes. 4 cases underwent CT scan and enhanced scan, compared with muscle, 3 cases showed low density, 1 case of equal density, 2 cases of non-uniformity enhancement, 2 cases showed no significant enhancement; 5 cases underwent ultrasound examination, 2 cases were hypoechoic hypoechoic region, 3 cases were heterogeneous mixed echogenic region, and 1 case showed low concentration by ~(18)F-FDG-PETCT. Conclusion Angiomyxomas mostly occur in young and middle-aged women, with low or mixed echogenic ultr asound and progressive heterogeneity of CT enhancement. MR, like CT, show a gradual enhancement of the lesion but show characteristic stratification or vortex sign, PETCT for low uptake, these characteristics contribute to the correct diagnosis of the disease.
Objective To investigate the imaging features of invasive angio-myxoma(AAM) and superficial angio-myxoma(SA) to improve the understanding of this disease. Methods We retrospectively analyzed of 11 cases of pathologically confirmed AAM and SA 3 cases of complete imaging data. There were 4 males and 10 females, aged 22～58 years, with mean age of 28 years old, including 1 case of PETCT, 4 cases of CT, 5 cases of US, 8 cases of MRI, the clinical features and imaging findings of AAM and SA. Results Four cases were located in the pelvis, four cases were located in the upper abdomen, one case was vulvar subcutaneous, one case was vaginal, one case was liver, one case was ear, one case was scrotal and one case was axillary. 8 cases underwent MRI examination. Compared with the muscle, the lesions showed high T_2WI signal in 6 cases, mixed signal in 2 cases, T_1WI low signal in 7 cases and equal signal in 1 case. All 8 cases underwent enhanced examination, 2 cases showed progressive enhancement, 1 case mild enhancement, 5 cases of non-uniformity was significantly enhanced, 5 cases of typical whirlpool-like or stratified changes. 4 cases underwent CT scan and enhanced scan, compared with muscle, 3 cases showed low density, 1 case of equal density, 2 cases of non-uniformity enhancement, 2 cases showed no significant enhancement; 5 cases underwent ultrasound examination, 2 cases were hypoechoic hypoechoic region, 3 cases were heterogeneous mixed echogenic region, and 1 case showed low concentration by ~(18)F-FDG-PETCT. Conclusion Angiomyxomas mostly occur in young and middle-aged women, with low or mixed echogenic ultr asound and progressive heterogeneity of CT enhancement. MR, like CT, show a gradual enhancement of the lesion but show characteristic stratification or vortex sign, PETCT for low uptake, these characteristics contribute to the correct diagnosis of the disease.
引文
[1] 钟小梅, 梁长虹. 血管黏液瘤临床、病理与影像学表现[J]. 国际医学放射学杂志, 2011, 34(5):464-466.
[2] Steeper TA, Rosai J. Aggressive angiomyxoma of the female pelvis and perineum. Report of nine cases of a distinctive type of gynecologic soft-tissue neoplasm [J]. American Journal of Surgical Pathology, 1983, 7(5): 463.
[3] Allen PW, Dymock RB, Maccormac LB. Superficial angiomyxomas with and without epithelial components. Report of 30 tumors in 28 patients [J]. American Journal of Surgical Pathology, 1988, 12(7): 519-30.
[4] 苏琴芬, 王伟民, 龙雯晴,等. 女阴侵袭性血管粘液瘤的临床及病理特征[J]. 现代妇产科进展, 2004, 13(5):356-358.
[5] 郭瑞江, 齐跃, 刘水策,等. 侵袭性血管黏液瘤12例临床分析及文献复习[J]. 中国实用妇科与产科杂志, 2014,(1):55-58.
[6] Mccluggage WG. A review and update of morphologically bland vulvovaginal mesenchymal lesions [J]. International Journal of Gynecological Pathology, 2005, 24(1): 26-38.
[7] 崔陶, 方芳. 侵袭性血管粘液瘤临床病理特征及研究进展[J]. 现代妇产科进展, 2007, 16(10):787-789.
[8] Iezzoni JC, Fechner RE, Wong LS, et al. Aggressive angiomyxoma in males: a report of four cases [J]. American Journal of Clinical Pathology, 1995, 104(4): 391-396.
[9] Kim HS, Gou YK, Lim SJ, et al. Giant superficial angiomyxoma of the vulva: a case report and review of the literature [J]. Journal of Cutaneous Pathology, 2010, 37(6): 672-677.
[10] Brunelle S, Bertucci F, Chetaille B, et al. Aggressive angiomyxoma with diffusion-weighted magnetic resonance imaging and dynamic contrast enhancement: a case report and review of the literature [J]. Case Reports in Oncology, 2013, 6(2): 373.
[11] Stewart ST, Mccarthy SM. Case 77: aggressive angiomyxoma [J]. Radiology, 2004, 233(3): 697-700.
[2] Steeper TA, Rosai J. Aggressive angiomyxoma of the female pelvis and perineum. Report of nine cases of a distinctive type of gynecologic soft-tissue neoplasm [J]. American Journal of Surgical Pathology, 1983, 7(5): 463.
[3] Allen PW, Dymock RB, Maccormac LB. Superficial angiomyxomas with and without epithelial components. Report of 30 tumors in 28 patients [J]. American Journal of Surgical Pathology, 1988, 12(7): 519-30.
[4] 苏琴芬, 王伟民, 龙雯晴,等. 女阴侵袭性血管粘液瘤的临床及病理特征[J]. 现代妇产科进展, 2004, 13(5):356-358.
[5] 郭瑞江, 齐跃, 刘水策,等. 侵袭性血管黏液瘤12例临床分析及文献复习[J]. 中国实用妇科与产科杂志, 2014,(1):55-58.
[6] Mccluggage WG. A review and update of morphologically bland vulvovaginal mesenchymal lesions [J]. International Journal of Gynecological Pathology, 2005, 24(1): 26-38.
[7] 崔陶, 方芳. 侵袭性血管粘液瘤临床病理特征及研究进展[J]. 现代妇产科进展, 2007, 16(10):787-789.
[8] Iezzoni JC, Fechner RE, Wong LS, et al. Aggressive angiomyxoma in males: a report of four cases [J]. American Journal of Clinical Pathology, 1995, 104(4): 391-396.
[9] Kim HS, Gou YK, Lim SJ, et al. Giant superficial angiomyxoma of the vulva: a case report and review of the literature [J]. Journal of Cutaneous Pathology, 2010, 37(6): 672-677.
[10] Brunelle S, Bertucci F, Chetaille B, et al. Aggressive angiomyxoma with diffusion-weighted magnetic resonance imaging and dynamic contrast enhancement: a case report and review of the literature [J]. Case Reports in Oncology, 2013, 6(2): 373.
[11] Stewart ST, Mccarthy SM. Case 77: aggressive angiomyxoma [J]. Radiology, 2004, 233(3): 697-700.