盆部原发性肿瘤多层螺旋CT表现特征及其解剖、病理学基础

Extra-organic Primary Tumor in Pelvis:Correlation of Multi-detector Row Computed Tomography,Anatomy and Pathology

通过对证实的20例盆部原发性肿瘤行多层螺旋CT(MDCT)增强扫描并行三维重建,以明确其MDCT影像特征表现及其解剖、病理学基础。结果表明:瘤体完全位于盆部14例,同时累及盆腔和腹部6例。位于盆部腹膜腔内8例(3例恶性肿瘤同时累及腹膜外结构),男性位于直肠膀胱陷凹(2例)而女性位于直肠子宫陷凹(3例)(共62.5%),两陷凹内多为生殖细胞源性肿瘤(3/5例,60.0%)。盆腹膜外间隙12例,位于直肠后间隙(5例)和直肠旁间隙(5例)(10/12例,83.3%),两间隙内多为生殖细胞源性肿瘤(7/10例,70.0%)。淋巴瘤累及左侧膀胱旁间隙和直肠旁间隙。钙化6例,见于良性畸胎瘤4例,神经鞘膜瘤和恶性畸胎瘤各1例。脂肪见于7例肿瘤,其中良性畸胎瘤4例,恶性畸胎瘤、混合性生殖细胞瘤和脂肪肉瘤各1例。MDCT能够清晰显示盆部原发肿瘤的解剖部位,其三维重建图像可提供更丰富信息,对肿瘤的良恶性可做出初步判断。

The purpose of this study was to investigate the correlation between multi-detector row CT （MDCT） features, pathological findings and the anatomic basis of extra-organic primary tumors in pelvis so as to improve the document diagnosis of these entities. We retrospectively analyzed the MDCT manifestations of 20 cases with surgical- ly and/or pathologically evidenced diagnoses of extra-organic primary tumors in pelvis. The results showed that, in 14 cases, the tumors were located in the pelvis, and 6 of them involved both pelvis and hypogastrie zone. There were 8 tumors located in the peritoneal cavity of the pelvis, and 3 of them also involved the extraperitoneal space of the pelvis. In the peritoneal cavity, 2 tumors of male patients were located in the rectovesical pouch while 3 tumors of fe- male patients were located in the rectouterine pouch. The majority of entities in these 2 pouches were germ cell tumors（3/5 cases, 60.0~/00 ）. In the extraperitoneal space, 5 of 12 tumors were located in the pararectal space and 5 of them were located in the retrorectal space. The majority entities of these 10 cases were germ cell tumors（7/10 cases, 70. 0%）. Lymphoma mainly involved paravesical and pararectal space in disorder. Calcification occurred in 6 cases, including 4 cases of teratoma, 1 case of neurilemmoma, and 1 case of malignant teratoma. The fatty element occurred in 7 masses, including 4 cases of teratoma, 1 case of malignant teratoma, 1 case of mixed germ cell tumor, and 1 case of liposarcoma. MDCT with multi-planar reconstruction （MPR） could more clearly reveal the anatomic location of the extra-organic primary tumor in pelvis, could unveil the tumor＇s relationship with its surrounding organs, and could help to differentiate benign tumors from malignant tumors.