前列腺肉瘤的临床表现与MRI诊断

Clinical and MRI Features of the Prostate Sarcoma

目的:探讨前列腺肉瘤的临床表现及MRI影像特征,提高诊断水平。方法:3例前列腺肉瘤,年龄23-45岁,中位数年龄25岁,3例均做快速自旋回波序列T1WI和T2WI轴位、矢状位和冠状位平扫,2例做增强扫描。结果:腺泡性横纹肌肉瘤2例,间质来源无法分类肉瘤1例。从始发症状到确诊约5-18月,临床症状为进行性排尿困难(2例),尿频(1例),下腹胀痛(2例),血尿(1例)。3例术前行血清酸性磷酸酶(PAP),碱性磷酸酶(AKP)及前列腺特异性抗原(PSA)检查均正常。2例2期均行手术及放化疗,1例3期未行手术,仅做化疗。术后随访2例生存8-15月,1例失访。MRI显示前列腺显著增大,呈榨菜分叶状占据盆腔的大部分,最大病灶为8.5 cm×8.3 cm×10.4 cm。T1WI信号不均,呈等或稍低信号,T2WI呈中高混杂信号,正常前列腺结构消失,中央带和外周带分界不清。1例精囊腺侵犯。增强扫描病灶明显强化,部分出现局灶性坏死区。结论:前列腺不规则显著增大及异常强化,中央带与外周带分界不清。病人年龄较轻,临床以排尿困难、下腹坠胀、尿频、血尿为主,血清PSA在正常范围,提示前列腺肉瘤。前列腺肉瘤恶性程度高,发展快,死亡率高。

Objective： To study the clinical and MRI features of prostate sarcoma. Methods： Three cases of prostate sarcoma identified by pathology were enrolled in this study. Both the clinical and MRI data were review. Results： Among the three prostate sarcomas, two cases were glandular rhabdomyosarcoma, the other was sarcoma originated from interstitial tissue that could not be classified. The biggest focus in MRI was 8.5 cm×8.3 cm× 10.4 cm. The serum PSA, PAP and AKP levels were normal before operation. The first symptom was dysuria accompanied swelling pain in the lower abdomen and haematuria. Final diagnosis was made after 5-18 months. Average surviv- al year was no more than one year. The mass was huge in MRI, T1WI and T2WI signal were inhomogeneous and the normal prostate structure was destroyed. Conclusion： Dysuria and haematuria were main symptoms of the prostate sarcoma. Combined with the clinical appearance, MRI helps to diagnosis the prostate sarcoma.