阑尾黏液性肿瘤的CT诊断及鉴别诊断

CT diagnosis and differential diagnosis of appendix mucinous tumor

目的:探讨阑尾黏液性肿瘤的CT诊断及鉴别诊断。方法:回顾性分析21例经手术病理证实的阑尾黏液性肿瘤的临床资料及CT表现,其中阑尾黏液囊肿12例,黏液性囊腺瘤5例,黏液性囊腺癌4例。结果:阑尾黏液囊肿(n=12)表现为右下腹类圆形、管状或分节状囊性肿块,囊内密度均匀,未见明显分隔;囊壁薄,4例见多发钙化,增强后囊壁无或轻度强化,未见壁结节;5例位于阑尾远端的囊肿中,2例阑尾近端结石嵌顿。阑尾黏液囊腺瘤(n=5)表现为阑尾区类圆形,长管状囊性肿块影,囊壁较薄,2例囊腔见多发分隔,其中1例可见壁结节,增强后均呈轻度强化。阑尾黏液囊腺癌(n=4)呈分叶状囊实性肿块,囊内密度不均,囊腔见多发分隔,囊壁及分隔厚薄不均,增强后囊壁呈中、高度强化,肿瘤与周围组织粘连,腹腔假性黏液瘤形成2例,其中1例术后复发。结论:阑尾黏液性肿瘤的CT表现具有一定特征性,结合临床及实验室检查可作出明确诊断,对指导临床治疗有重要价值。

Objective：To study the CT diagnosis and differential diagnosis of appendix mucinous tumor.Methods：The CT manifestations of 21 cases with appendix mucinous tumor proved by surgery and pathology were retrospectively analyzed,including appendiceal mucocele（12 cases）,mucinous cystadenoma（5 cases）,and mucinous cystadenocarcinoma（4 cases）.Results：Appendiceal mucocele（12 cases） demonstrated oval,segmented or segmented stripe-like cystic mass in the right lower quadrant,with thin cystic wall and no septum,homogeneous in density.The cystic walls were mildly enhanced or not enhanced and no wall nodule,4 cases showed calcification of cystic wall.In 5 cases with appendiceal mucocele at the distal end,2 were found incarcerated fecalith in the proximol end of appendix.Mucinous cystadenoma（5 cases） demonstrated oval or segmented stripe-like cystic mass with thin wall,2 showed multiple septations,1 was observed with cystic wall nodule,and mild enhancement after contrast-enhanced scanning.Mucinous cystadenocarcinoma（4 cases） appeared as cystic-solid mass,with uneven thickness of septation and cystic wall and with moderate or marked enhancement,adhesion of the tumor and surrounding tissues was observed.2 had peritoneal pseudomyxoma,and 1 recurred after surgery.Conclusion：Since CT manifestations of appendix mucinous tumor possess some specific characteristics,along with clinical and laboratory examination,clarified diagnosis can be made and it is of important value for guiding clinical treatment.