成人型卵巢颗粒细胞瘤的MRI表现与病理对照分析

MRI diagnosis of adult type ovarian granular cell tumor

目的探讨卵巢颗粒细胞瘤的MRI表现特点,并与病理结果对照。方法回顾性分析19例经手术与病理证实的卵巢颗粒细胞瘤患者的临床和MRI资料,并分析其MRI表现特征及其病理基础。结果 19例患者肿瘤均为单发,呈边缘清晰的球形或分叶状肿块。19例术前诊断正确14例(74%)。MRI平扫主要表现:子宫附件区边界清楚、包膜完整的囊实性、囊性及实性肿块。12例为多房蜂窝状囊实性肿块,T_1WI呈等低混杂信号,T_2WI呈混杂高信号,内有多发大小不等的囊性变,囊内壁光滑;4例为囊性肿块,其中2例为单房,另外两例为多房性,囊内壁均较光滑,T_1WI呈低信号,T_2WI呈高信号;3例为实性肿块,T_1WI及T_2WI与同层肌肉信号相仿,其中1例合并出血。合并症:8例子宫增大,内膜增厚,盆腔积液,4例合并子宫肌瘤(1例同时合并输卵管系膜囊肿),增强扫描19例患者肿瘤实性部分、囊内分隔均明显强化,囊性部分无强化。卵巢颗粒细胞瘤的MR表现与病理表现基本一致。结论卵巢颗粒细胞瘤MRI表现具有一定的特征性,诊断该病的提示性征象为:①附件区囊实性肿块(多囊泡),间有厚壁分隔,囊内壁光滑;②多合并子宫体积增大,内膜增生。

Objective To study the MRI features of adult type ovarian granulosa cell tumor. Methods MRI of 19 patients with pathologically proved ovarian granulosa cell tumors was retrospectively analyzed and compared with pathologic findings. Results All 19 patients presented with solitary round or lobulated masses with small patchy necrotic areas, of whom 14 patients （74%） were correctly diagnosed by MRI before surgery. The main MRI findings were well-defined encapsulated mixed cystic and solid （12） masses with mixed low to intermediate T1 and high T2 signal intensities as well as multiple cystic areas of variable size. Of 4 cystic masses, 2 were solitary cysts and 2 were septated with smooth capsules, low T1 and high T2 signal intensities. The remaining 3 tumors were solid with homogeneous T1 and T2 signal intensities similar to muscles. There was hemorrhage in 1 solid tumor. Other findings included uterine enlargement with endometrial thickening and free pelvic fluid （8）, uterine fibroids （4）, and mesangial cyst of the fallopian tube （1）. The solid components and the walls of the cysts enhanced with intravenous contrast. The MRI appearances correlated well with pathology. Conclusions MRI features of mixed cystic and solid masses with thick septa and smooth cyst wall associated with uterine enlargement and endometrial hyperplasia may allow preoperative diagnosis of ovarian granulosa cell tumor.