睾丸卵黄囊瘤的超声表现

Sonographic features of yolk sac tumor in testis

目的探讨睾丸卵黄囊瘤的超声表现。方法回顾性分析经病理确诊的12例睾丸卵黄囊瘤患者的声像图特征,包括受累睾丸数目、肿瘤生长方式、大小、形态、边界、包膜、内部回声、肿瘤内部无回声区、钙化、血供等。结果12例睾丸卵黄囊瘤中小儿10例,成人2例。血清甲胎蛋白阳性(>20μg/L)11例,阴性(≤20μg/L)1例。右侧睾丸4例,左侧8例,均为单侧睾丸肿瘤。肿瘤最大径1.8～10.3cm,平均(4.6±3.0)cm。1个肿瘤呈弥漫性改变,未见明确结节;其余11个表现为局灶性占位,其中9个肿瘤边界清楚,2个边界不清;形态不规则2个,圆形4个,卵圆形5个;5个肿瘤可见完整低回声包膜,2个可见不完整低回声包膜,其余4个未见明确包膜;8个肿瘤内部出现多个不规则片状无回声区;1个肿瘤内部可见钙化灶。12个睾丸卵黄囊瘤中6个肿瘤有彩色多普勒检查记录,肿瘤内部血供均为丰富。结论小儿睾丸肿物合并血清甲胎蛋白升高,超声检查发现肿物边界清楚,内部见多个弥漫分布的小片状无回声区,血供丰富,高度提示睾丸卵黄囊瘤。

Objective To evaluate the sonographic features of testicular yolk sac tumor （YST）. Methods Twelve patients with pathologically proved testicular YSTs were evaluated by sonography. The number of testis involved, tumor growth pattern, tumor size, configuration, boundary, capsule, internal echo, liquefaction inside the tumor, calcification, and blood supply were collected as the sonographic features. Results Twelve cases of testicular YSTs included 10 children and 2 adults. The serum alpha-fetoprotein was positive（〉 20 μg/L） in 11 patients and negative（≤20 ug/L） in one patient. All of the YSTs were unilateral, 4 in the right testicle and 8 in the left. The mean diameter of the tumor was 4.6 ± 3.0 cm （range, 1.8-10.3 cm）. One YST showed diffusely enlarged testicle and no obvious mass was found. The other 11 YSTs showed space-occupying lesions in the testis. In the other 11 YSTs, 9 were well-defined and 2 ill-defined; 2 was irrgular, 4 round, and 5 ovoid; The intact lower echo capsule was observed in 5, incomplete capsule in 2, and no obvious capsule in the remaining 4 cases ; multiple irregular small patch-like anechoic spaces were found in 8 cases; The calcification was in one case. Abundant blood flow signals were found in all the 6 YSTs with record of color Doppler flow data. Conclusions It is highly suspicious of testicular YST when a testicular mass is found in children with elevated serum alpha-fetoprotein and the sonographic features of well-defined intra-testicular mass, multiple irregular small patch-like anechoic spaces within the lesion, as well as intralesional abundant flow signals.