卵巢子宫内膜样癌的CT表现及误诊分析

CT features and misdiagnosis of ovarian endometrioid carcinoma

目的探讨卵巢子宫内膜样癌（OEC）的CT表现及误诊原因,以提高对该病的认识。方法回顾性分析经手术病理证实的10例OEC的CT表现及临床资料。结果 10例OEC均为单侧,左侧6例,右侧4例。肿瘤最大径4.5-17.0cm,平均9.0cm。CT平扫均表现为盆腔内附件区的囊实性肿块,其中囊性成分为主8例,实性成分为主2例,实性成分均未见钙化;肿瘤形态不规则,边界部分模糊8例,形态规则呈类圆形,边界清楚光滑2例;增强后肿瘤实性成分中等强化,CT值平均升高了25-30HU。10例中合并子宫内膜增生3例,子宫体内膜癌2例,同侧卵巢巧克力囊肿1例,子宫肌瘤4例,子宫腺肌症1例,少量腹水6例。10例OEC术前均未能正确诊断,其中仅提示为卵巢恶性肿瘤4例,误诊为囊腺癌3例、囊腺瘤1例、卵巢巧克力囊肿1例、子宫肌瘤变性1例。结论典型的OEC多表现为盆腔内附件区形态不规则的囊实性肿块,钙化少见,易合并子宫内膜增生或内膜癌,增强扫描肿瘤实性成分中等强化。肿瘤缺乏一定的特征性、定位不准确、部分肿瘤的影像表现不典型和对该肿瘤的影像表现缺乏足够的认识是误诊的主要原因。

Objective To investigate CT scan and the cause of misdiagnosis in ovarian endometrioid carcinoma（ OEC）.Methods CT findings in 10 patients with OEC confirmed by surgery and pathology were analyzed retrospectively. Results All the patients were unilateral lesions（ 6 at left,4 at right）. The diameter of tumor ranged from 4. 5 - 17. 0 cm with an average of9. 0 cm. On unenhanced CT,all the tumors were in pelvic cavity of adnexauteri,cystic-solid lesions were found in 8 cases,solid lesions in 2 cases. There was no calcification in solid lesions. 8 cases were ambiguity and irregular in shape. 2 cases were clear in shape and appeared round shape. The solid component of all tumors displayed intermediate enhancement on post-contrast views,the CT value incresed in 25 - 35 HU. 3 cases were accompanied with endometrial hyperplasia,2 cases were accompanied with merge endometrial carcinoma,1 case was accompanied with Chocolate cyst of ovary,4 cases were accompanied with myoma,1 case was accompanied with glandulae uterinae,6 cases were accompanied with few asctites. 10 cases of OEC preoperatively failed to make the correct diagnosis,4 cases were only diagnosed malignant tumor of ovary,3 cases were misdiagnosed as cystadenocarcinoma and 1 case as cystadenoma,1 case as Chocolate cyst of ovary,and 1 case as hysteromyoma. Conclusion The typical OEC is cystic-solid mass in pelvic cavity of adnexauteri and few calcification,which is often accompanied with endometrial hyperplasia or merged endometrial carcinoma,the solid component was displayed intermediate enhancement on post-contrast views.The main causes of misdiagnosis are the tumor lack of adequate understanding,some tumors are lack of typical image performance and mark.