腹腔内型隐睾精原细胞瘤的MSCT诊断

The MSCT diagnosis of seminoma in intraabdominal undescended testis

目的：探讨腹腔内型隐睾精原细胞瘤的MSCT影像表现特点,加强对本病的认识。方法：回顾性分析经手术病理证实的15例腹腔内型隐睾精原细胞瘤的临床资料及CT影像表现,并与病理结果对照。15例均行CT平扫及增强扫描。结果：15例全部为男性,发病年龄19-38岁,平均29岁。肿块均位于盆腔内,呈囊实性改变,境界清楚,密度不均,实性成份位于肿块边缘,中央见不规则的低密度坏死区,内均见条状分隔,所有肿块内均未见脂肪和钙化。增强后均呈不均匀强化,肿块边缘实性成分轻度强化,中央不规则低密度坏死区无强化,11例于动脉期可见增粗扭曲的睾丸动脉供血,静脉期9例可见增粗扭曲的睾丸静脉引流。同侧阴囊内睾丸缺如,右侧12例,左侧3例。CT分期均与手术病理符合。结论：腹腔内型隐睾精原细胞瘤少见,临床症状隐蔽,当临床遇到年轻男性患者,发现下腹部肿块,应仔细检查双侧阴囊内睾丸是否缺如,警惕腹腔内型隐睾精原细胞瘤的可能性,CT增强见到增粗睾丸动脉和（或）引流静脉则可确诊,及早发现及时治疗对腹腔内型精原细胞瘤的预后有重要的意义。

Objective： To assess the imaging features of MSCT in diagnosing seminoma in intraabdominal undescended testis, and to strengthen the understanding of the disease. Methods： MSCT images of 15 cases of seminoma of abdominal testis proved by pathology and surgery were analyzed, and the results were compared with pathology. All of the 15 cases underwent plain and enhanced MSCT scanning. Results： All of the 15 cases were male, age ranged from 19 to 38 years old,with an average age of 29 years. The lesions were located in the pelvic cavity, with cystic change, clear realm and uneven density. Solid component was located in the edge of the mass, and irregular necrosis of low density was seen in the center.Stripy separations were seen in all the masses, without fat and calcification. Enhancement was inhomogeneous, and the margin of solid component was slightly enhanced, without strengthening of the central irregular low density necrosis. Thickened and tortuous testicular arteries were seen in 11 cases in the arterial phase, and thickened and twisted testicular veins were seen in 9 cases in the venous phase. Ipsilateral testis was abscent, 12 cases in the right and 3 cases in the left. CT staging was consistent with operation and pathology. Conclusion： Seminoma in intraabdominal undescended testis is rare, and the clinical symptoms are insidious. When a young male patient found a mass in the lower abdomen, testicular absence or not should be carefully checked, being alert to the possibility of senminoma in intraabdominal undescended testis. Thickened testicular arteries and/or draining veins on enhanced CT can help the diagnosis, and early finding is important for the prognosis.