纵隔非畸胎类生殖细胞瘤CT表现及与胸腺癌鉴别诊断价值分析

The CT Features of Non-teratomatous Germ Cell Tumors and Its Differential Diagnosis Value for Thymic Carcinomas

目的:探讨纵隔非畸胎类生殖细胞瘤CT表现,并与前纵隔最常见恶性肿瘤胸腺癌行鉴别诊断分析。方法:回顾性分析病理证实且有完整临床及CT增强资料的纵隔非畸胎类生殖细胞瘤7例,分析各类纵隔非畸胎类生殖细胞瘤CT表现;同时比较7例非畸胎类生殖细胞瘤与11例胸腺癌临床及各项CT指标的差异,评估肿瘤强化均匀性,肿瘤内坏死灶情况,肿瘤内钙化,肿瘤形态,肿瘤分叶,肿瘤外侵及肺内及胸膜转移等情况CT表现对非畸胎类生殖细胞瘤与胸腺癌鉴别诊断的价值。结果:纵隔非畸胎类生殖细胞瘤均位于前上纵隔,影像表现为不均强化且含较大面积低密度坏死区域的实性肿块,边缘多模糊不清且形态不规则,就诊时肿瘤多较大且常压迫临近腔静脉及同侧肺门结构。本组非畸胎瘤类生殖细胞瘤与胸腺癌患者比较,发病年龄更年轻,非畸胎类生殖细胞瘤组患者肿瘤较胸腺癌组大,且肿瘤内密度相对较低,同时肿瘤内低密度坏死情况较胸腺癌明显。结论:多层螺旋CT增强扫描对于纵隔非畸胎类生殖细胞瘤诊断及与胸腺癌鉴别诊断有一定价值。

Objective： To study the CT features of non-teratomatous germ cell tumors and make differential diagnosis analysis between non-teratomatous germ cell tumors and thymic carcinomas. Methods： The clinical and image data of 7 non-teratomatous germ ceil tumors patients proved by pathology were retrospective analyzed and the different clinical and CT features between non-teratomatous germ cell tumors and thymic carcinomas were compared. The value of CT features inclu- ding inhomogenous of tumors, necrosis in the tumors,calcification,lesion morphology,lobulated,the edge of lesion,lung or pleural metastasis of tumors were evaluated to find out the useful features in differentiating non-teratomatous germ cell tumors from thymic carcinomas. Results： All the masses located in the anterior mediastinum. Non-teratomatous germ ceil tumors usually appeared as irregular,giant and lobulated solid-dominant masses with large hypodense necrosis area. Com- pared with thymic carcinomas, non-teratomatous germ cell tumors were larger and the age of onset is younger. The hypo- dense,hyperdense of plain CT scan and hypodense of enhanced CT scan were lower than that of the thymic carcinomas. The hypodense necrosis area was relatively lager in non-teratomatous germ cell tumors, Conclusion： CT is useful in the diagnosis of non-teratomatous germ cell tumors and the differential diagnosis for thymic carcinomas.