恶性中胚叶混合瘤的临床特征及MRI诊断

Clinical characters and MRI diagnosis of malignant mesoderm mixed tumor

目的探讨恶性中胚叶混合瘤(MMMTs)临床及MR特点,提高对本病的认识。方法回顾分析南京医科大学第一附属医院妇科经手术和病理证实的MMMTs 11例,分析其临床和MR特点。结果随访11例患者的平均发病年龄56岁,最常见症状为异常阴道出血,以绝经后出血最多,占80%~90%;常伴下腹或盆腔疼痛。可有阴道排液或伴有组织样物排出。MR示明显软组织肿块,内可见破碎的软组织信号影,T1WI呈等低信号,T2WI呈等稍高信号影,DWI呈混杂高信号影,增强扫描早期呈混杂片状强化,平衡期强化程度明显低于子宫肌层,呈混杂稍低信号影。肿瘤生长迅速,短时间内即可迅速长大,信号不均匀。晚期患者可有腹水或远处转移,呈消瘦、乏力、发热等全身症状。结论围绝经期妇女出现阴道异常出血,腹胀或腹痛症状时要警惕恶性中胚叶混合瘤可能,MRI有助于术前诊断。

Objective o explore analyze clinical and MR characters of malignant mesoderm mixed tumors（MMMTs） so as to improve the understanding of this disorder. Methods The clinical manifestations and MR findings of 11 cases of MMMTs from the department of gynecology, the first affiliated hospital of Nanjing Medical University, which were confirmed by operation and pathology, were retrospectively analyzed in this work. Results By following up of 11 patients, the average of age was 56-year- old, the most common symptom was abnormal vaginal bleeding, especially, the post＇menstrual bleeding, accounting for 80% 90%, and hypogastralgia, pelvic pain or, sometimes, vaginal discharges （water or soft tissue） always appeared. MR demonstra- ted the obvious soft tissue mass with signals of broken soft tissue inside, hetero-hypo-intensity in T1 WI, hereto-intensity or slight hyper-intensity in T2 WI, and mixed hyper-intensity in DWI. The mixed enhancement signal exhibited in early stage and mixed hy- po-intensity in late stage, which was lower than the enhancement of the myometrium. The growth of tumor was fast and formed a large mass during a short period of time, which was shown uneven signal in intensity. At the late stage, the patients suffered from ascites or metastasis, who presented with marasmus, fatigue, fever, and or so on. Conclusion For a woman in menopause, who presents with abnormal bleeding from vagina, abdominal distension or pain, MMMTs should be highly suspected. MRI is helpful for preoperative diagnosis of MMMTs.