小儿盆腔及泌尿生殖系横纹肌肉瘤的影像诊断

Imaging Diagnosis of Genitourinary and Pelvic Cavity of Rhabdomyosarcoma in Children

目的 探讨儿童盆腔及泌尿生殖系横纹肌肉瘤 (RMS)的尿路造影和CT表现及其诊断价值。资料与方法 回顾性分析 2 0例经手术及活检病理证实的原发于盆腔及泌尿生殖系RMS的影像学资料。其中 10例经静脉肾盂造影 (IVP)检查 ,3例经膀胱尿道造影 (VCUG)检查 ,10例经CT检查 ,1例经MRI检查。结果 8例膀胱RMS的IVP、CT表现为膀胱内葡萄状充盈缺损 ,膀胱颈部与耻骨联合间距增宽 ,VCUG可见肿物延伸至后尿道 ;4例前列腺RMS表现为后尿道肿物压迫膀胱颈部并使其抬高、环绕尿道的盆底部包块。 6例盆腔RMSIVP及CT表现为盆腔包块 ,压迫膀胱移位、变形 ,膀胱壁轻度浸润不规则 ,输尿管下段浸润者可有轻度输尿管及肾盂积水。 1例尿道RMS表现为尿道内充盈缺损 ,1例阴道RMS ,IVP表现为膀胱颈部充盈缺损。结论 IVP及VCUG能明确诊断原发于膀胱、前列腺、尿道的RMS及上尿路继发病变 ;CT及MR可进一步了解起自阴道、前列腺、盆腔的RMS及其与周围器官的关系。

Objective To discuss urography and CT signs of genitourinary and pelvic cavity rhabdomyosarcoma in children, and the value of diagnosis. Materials and Methods Twenty cases with primary rhabdomyosarcoma in pelvic cavity and genitourinary system which pathological proved were retrospectively analyzed. Ten cases take IVP, three cases take VCUG, ten cases take CT, one case take MR examination.Results The CT scans and IVP of eight cases with bladder RMS showed the polypoid filling defects in the bladder; the distance between the neck of bladder and pubic symphysis was enlargement. The mass protruded into the posterior urethra in VCUG. Four cases with prostate RMS manifested as mass oppressed the neck of bladder that was raised, the pelvic tumor surrounded the urethra. Six cases with pelvic RMS showed the pelvic mass oppressed the bladder and infiltrate the wall of bladder, the irregular incrassate wall and the deformative bladder was shown in pelvic CT and IVP. The mass led to hydronephrosis if the inferior ureter was infiltrated. Filling-defects in the urethra were manifested in one cases of urethral RMS. Filling-defects in the neck of bladder were manifested by IVP of one case with vagina RMS.Conclusion IVP and VCUG can diagnosis RMS arise from the bladder, urethra, prostate and secondary lesion of superior urethra; CT and MR scans can realize further about the tumor come from vagina, prostate, pelvic and the relationship of the tumor and surrounding organs.