29 余小多 盆腔腫瘤疑難病例討論-全國(guó)腫瘤影像診斷學(xué)習(xí)班

盆腔病例中國(guó)醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院影像診斷科病例一術(shù)后病理“右側(cè)卵巢粘液性囊腺瘤”CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences病史CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesT2WI脂肪抑制序列CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences ADC值 ADC值=1.68×10-3mm2/sCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences增強(qiáng)掃描矢狀位延遲期增強(qiáng)掃描矢狀位延遲期CancerInstitute&Hospital,ChineseAcademyofMedicalSciences增強(qiáng)掃描橫斷位延遲期CancerInstitute&Hospital,ChineseAcademyofMedicalSciences增強(qiáng)掃描冠狀位延遲期增強(qiáng)掃描冠狀位延遲期CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences?TCT：有異型腺細(xì)胞，考慮為高分化腺癌細(xì)胞?活檢：頸管內(nèi)膜組織，小灶腺體增生活躍，因送檢組織取材表淺，目前尚不能除外微偏腺癌可能CancerInstitute&Hospital,ChineseAcademyofMedicalSciences臨床醫(yī)師先行宮頸錐切術(shù)?錐切標(biāo)本術(shù)中病理提示腺癌，改行經(jīng)腹廣泛全子宮+左側(cè)附件+大網(wǎng)膜+盆腔淋巴結(jié)清掃術(shù)CancerInstitute&Hospital,ChineseAcademyofMedicalSciences可見(jiàn)一腫物，約5.5×3×1.8cm,切面灰白質(zhì)硬在多個(gè)囊腔形成,部分表面呈息肉CancerInstitute&Hospital,ChineseAcademyofMedicalSciences?宮頸粘液腺癌，大部分呈微偏腺癌，少部分,累及宮體下段，未累及宮頸壁外纖維脂肪組織,雙側(cè)宮旁CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences?少見(jiàn)，約占宮頸腺癌的l～3%CancerInstitute&Hospital,ChineseAcademyofMedicalSciences?病理上最可靠的診斷標(biāo)準(zhǔn)是腺體雜亂排列，浸潤(rùn)深度小管分化的性索腫瘤（13-17%伴發(fā)Peutz-JegherCancerInstitute&Hospital,ChineseAcademyofMedicalSciences?治療策略與其他腺癌相仿–早期手術(shù)，中晚期放化療–與臨床分期相關(guān)CancerInstitute&Hospital,ChineseAcademyofMedicalSciences化CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences–ADC值低CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences長(zhǎng)圍斷CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences?FattanehA.Tavassoli,PeterDevilee,Pathologyandgeneticsoftumoursofthebreastandfemalegenitalorgans.?KaurH,SilvermanPM,IyerRB,etal.Diagnosis,Staging,andSurveillanceofCervicalCarcinomaAJRAmJRoentgenol.2003;180(6):1621-31.?LiuY,BaiR,SunH,LiuH,WangD.Diffusion-weightedmagneticresonanceimagingofuterinecervicalcancer.JComputAssistTomogr2009;33:858-62.?LiuY,YeZ,SunH,BaiR.ClinicalApplicationofDiffusion-WeightedMagneticResonanceImaginginUterineCervicalCancer.IntJGynecolCancer2015;25:1073-8.?KuangF,RenJ,ZhongQ,LiyuanF,HuanY,ChenZ.Thevalueofapparentdiffusioncoefficientintheassessmentofcervicalcancer.EurRadiol2013;23:1050-8.?ParkSB1,LeeJH,LeeYH,etal.Adenomamalignumoftheuterinecervix:imagingfeatureswithclinicopathologiccorrelation.ActaRadiol.2013;54:113-20.?LiG,JiangW,GuiS,XuC.Minimaldeviationadenocarcinomaoftheuterinecervix.IntJGynaecolObstet.2010;110:89-92.?LeeHK,KimSH,ChoJY,etal.UterineAdenofibromaandAdenosarcoma:CTandMRFindings.JComputAssistTomogr.1998;22:314-6lCancerInstitute&Hospital,ChineseAcademyofMedicalSciences病例二CancerInstitute&Hospital,ChineseAcademyofMedicalSciences?查體發(fā)現(xiàn)附件區(qū)腫物1月?實(shí)驗(yàn)室結(jié)果:CA125、CA199、CEA均正常CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesDWIT1雙回波-正相位DWIT1雙回波-正相位T2T2WI/FS-AXT1T1雙回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesDWIT1雙回波-正相位DWIT1雙回波-正相位T2T2WI/FS-AXT1T1雙回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesDWIT1雙回波-正相位DWIT1雙回波-正相位T2T2WI/FS-AXT1T1雙回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesDWIT1雙回波-正相位DWIT1雙回波-正相位T2T2WI/FS-AXT1T1雙回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesT2T2WI/FS-AXT1T1雙回波-正相位DWIDWIT1T1雙回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesT2T2WI/FS-AXT1T1雙回波-正相位DWIDWIT1T1雙回波-反相位CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences動(dòng)態(tài)增強(qiáng)掃描CancerInstitute&Hospital,ChineseAcademyofMedicalSciences動(dòng)態(tài)增強(qiáng)掃描CancerInstitute&Hospital,ChineseAcademyofMedicalSciences動(dòng)態(tài)增強(qiáng)掃描動(dòng)態(tài)增強(qiáng)掃描CancerInstitute&Hospital,ChineseAcademyofMedicalSciences矢狀位延遲增強(qiáng)掃描CancerInstitute&Hospital,ChineseAcademyofMedicalSciences冠狀位延遲增強(qiáng)掃描CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences來(lái)源于卵巢生殖細(xì)胞，發(fā)病率約占卵巢腫瘤10～20%組織發(fā)生來(lái)自減數(shù)分裂前細(xì)胞CancerInstitute&Hospital,ChineseAcademyofMedicalSciences?病理主要分為4型–成熟畸胎瘤：良性，最常見(jiàn)（97%），育齡期婦女，單囊為主/多囊，囊內(nèi)含毛發(fā)和皮質(zhì)樣物，囊壁頭節(jié)，頭節(jié)處可含多胚層組織–未成熟畸胎瘤，較少見(jiàn)，占卵巢畸胎瘤的3%，年輕患者，組織來(lái)源除三胚層成熟組織外，上可見(jiàn)未成熟組織，約32~58%發(fā)生轉(zhuǎn)移圍組織，較少發(fā)生淋巴管或?qū)W行轉(zhuǎn)移–單胚層或高度特異的腫瘤：卵巢甲狀腺腫、類癌和腺類癌、CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences?最常見(jiàn)的單胚層腫瘤，占卵巢全部畸胎瘤的2.7%，全部卵巢腫瘤的0.3%可分泌甲狀腺激素、甚至引起甲亢CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences,則邊界不清CancerInstitute&Hospital,ChineseAcademyofMedicalSciences性或?qū)嵭猿煞譃橹鞯纳僖?jiàn)?單囊者信號(hào)均勻，多囊者囊腔內(nèi)信號(hào)不一?囊壁及分隔較厚，可見(jiàn)鈣化灶?增強(qiáng)掃描甲狀腺組織顯著強(qiáng)化，囊內(nèi)容物無(wú)明顯強(qiáng)化CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences?囊腫大小不一?出血時(shí)間不同，囊內(nèi)信號(hào)各異?邊緣不規(guī)則，囊腫壁與鄰近結(jié)構(gòu)分界不清CancerInstitute&Hospital,ChineseAcademy