儿童阴囊内睾丸外肿物的CT和MRI表现

CT and MRI features of extratesticular scrotal masses in children

目的探讨儿童阴囊内睾丸外肿物的CT和MR特征。方法回顾性分析经手术病理证实的10例阴囊内睾丸外肿物的CT和MRI资料及临床病理资料,并进行文献复习。结果良性病变7例:婴儿纤维性错构瘤2例,异位副脾、血管畸形、静脉型血管瘤、脓肿、囊肿各1例;恶性病变3例,均为横纹肌肉瘤。临床表现均为阴囊区无痛性肿块,实验室检查多无特点。而影像学表现各异:婴儿纤维性错构瘤表现为阴囊区近腹股沟不均匀密度/信号肿物,增强后轻-中度强化;异位副脾表现为紧贴左侧睾丸上方边界清楚且密度均匀的结节灶,增强后明显均匀强化;血管畸形表现为阴囊内鞘膜下不规则形肿物,T_2WI部分见流空信号,增强后早期明显强化;静脉型血管瘤合并血栓形成表现为睾丸上方精索内侧类圆形边界清楚肿物,呈软组织密度,增强后大部分未见强化;脓肿表现为阴囊纵隔区类圆形肿物,边界模糊,T_2WI呈不均匀稍高信号,DWI呈高信号;囊肿表现为附睾头区典型边界清楚类圆形水样密度灶,增强后未见强化;横纹肌肉瘤表现为睾丸旁密度不均匀肿块,增强后明显强化,其中1例侵犯睾丸并远处转移。结论儿童阴囊内睾丸外肿物种类繁多,以良性病变多见,临床表现无特异性,部分病变具有一定的影像特征,推荐术前选择超声结合MRI检查。

Objective To evaluate the imaging features of extratesticular scrotal masses in children. Methods Imaging findings and clinical records were retrospectively analyzed in 10 children with extratesticular scrotal masses confirmed by surgery and pathology. Results Benign lesions（7） included 2 fibrous hamartomas of infancy, 1 ectopic spleen tissue, 1 vascular malformation, 1venous hemangioma, 1 abscess, and 1 cyst whereas malignancy was rhabdomyosarcoma in 3 children. All presented as painless scrotal masses with non-specific laboratory examinations. On CT and MRI, fibrous hamartoma of infancy appeared as heterogeneous scrotal masses near the inguinal canals with mild to moderate enhancement. The ectopic spleen tissue was a round, well-circumscribed nodule with intense homogeneous contrast enhancement superior to the left testis. Vascular malformation was seen as a mass with irregular shape under the tunica vaginalis with some flow voids on T_2-weighted imaging and early intense contrast enhancement. Venous hemangioma with thrombus formation exhibited a round well-defined mass with soft tissue density located above the testis and medial side of sperm cord, majority of which did not enhance. Abscess was a round heterogeneously hyperintense lesion on T_2-and diffusion-weighted imaging with ill-defined margins in the midline of the scrotum. Cyst showed typical round lesion with fluid density and no enhancement. Rhabdomyosarcomas demonstrated as heterogeneous markedly enhancing paratesticular masses, one of which invaded the testis and associated with distant metastasis. Conclusion Most extratesticular scrotal lesions in children are benign, some of which have characteristic imaging appearance. Preoperative assessment with ultrasound and MRI is recommended.