卵巢甲状腺肿的MSCT表现、病理对照与误诊分析

The Analysis of MSCT Findings,Pathological data and Misdiagnosis of Struma-Ovarii

目的分析卵巢甲状腺肿(SO)的MSCT表现,以期提高术前诊断准确率,减少误诊。方法回顾性分析经手术病理证实的18例SO的临床及影像学资料,并与病理结果作对照,分析其相应MSCT表现及误诊原因。结果 18例SO均为单侧附件肿块,呈圆形、椭圆形或分叶状,边界清楚;1例呈囊性,17例呈囊实性,其中7例含有少许脂肪;囊性部分平扫密度较高者14例,实性部分密度较高者(CT值>50 HU)14例;17例行CT增强,扫描后实质部分多呈中等(2例)或显著强化(12例)。15例伴有斑点状、线条状或蛋壳样钙化;13例可见腹腔积液,其中1例大量,1例中量,11例少量。镜下可见肿瘤由甲状腺滤泡样结构和富含血管及纤维组织的基质组成,滤泡腔内充满高蛋白凝胶样物质,滤泡上皮为单层立方上皮或柱状上皮,细胞无异型性。结论边界清楚的单侧囊实性肿块、特征性钙化、高密度囊腔及高密度实性部分、实质部分多呈显著强化是SO的特征性MSCT表现,合并胸、腹腔积液及肿瘤抗原升高常常是误诊的原因,结合病理学表现有助于减少误诊。

Objective To analyze the MSCT findings of struma ovarii（ SO）,so as to improve the preoperative diagnostic accuracy and reduce the rate of misdiagnoses. Methods A retrospective analysis was made on the basis of the clinical and imaging data of 18 cases of SO patients who were confirmed by operation and pathology. Pathologic results were set up as the control group,to analyze corresponding MSCT appearance and causes of misdiagnoses. Results All the 18 cases of SO were unilateral adnexal masses and showed round,elliptic or lobulated morphology with a well-defined margin. Furthermore,1 case of the masses was cystic,and the remaining 17 masses were cystic-solid,among which 7 cases contained a little fat; there were 14 cases which showed relatively high-density of the cystic part by plain scanning,and 14 cases with relatively high-density of the solid part（ value of CT over 50 HU）; 17 cases received CT enhanced scan,and the results indicated that moderate（ 2 cases） or significant enhancement（ 12 cases） were predominantly displayed. There were 15 cases with punctate,linear or eggshell calcification; 13 cases were found to have ascites（ 1 case of massive ascites,1 case of moderate ascites,and 11 cases with a small amount of ascites）. Tumors consisted of thyroid follicular structures and matrix rich in blood vessels and fibrous tissues could be observed under the microscope as well as follicular cavities which were filled with high protein protein gel-like substances; follicular epithelium was simple cuboidal epithelium or columnar epithelium,and cells were not heterotypic. Conclusion The characteristic features of MSCT in SO are unilateral cystic mass with clear boundary,characteristic calcification,high-density cavity,significant enhancement of the high-density solid and substantial parts. The complicated pleural effusion and ascites and increased resistance of tumor are often the cause for misdiagnoses. It is helpful to reduce the misdiagnoses by combining with pathologic findings.