子宫小叶样分割性平滑肌瘤的超声特征分析

Diagnosis and differential diagnosis of cotyledonoid dissecting leiomyoma of the uterus on sonography

目的总结子宫小叶样分割性平滑肌瘤(CDL)的超声影像学特征及鉴别诊断要点。方法分析2011年1月至2016年12月在首都医科大学附属北京妇产医院超声检查并经手术及病理证实为CDL患者的超声影像学特征,总结CDL超声鉴别诊断要点。结果 6例CDL术前超声显示肿物局限于子宫肌层5例,表现为子宫肌层内边界不规则、内部回声不均匀的实性肿物;彩色多普勒血流成像(CDFI)示肿物内部血流信号丰富;1例肿物突破子宫浆膜层,宫外部分表现为胎盘小叶样分格状的低回声肿物,彩色多普勒示肿物内部血流信号丰富。术前超声诊断为子宫肌瘤3例,误诊为子宫平滑肌肉瘤1例,子宫内膜间质肉瘤1例,子宫腺肌瘤1例。结论因子宫CDL有分割性生长方式及宫外扩张性生长的特点,术前超声易误诊为子宫恶性肿瘤,需仔细辨识。术前超声正确诊断有利于手术方式的选择,避免过度治疗。

Objective Cotyledonoid dissecting leiomyomawas a rare type of uterus tumors. Because of the lack of knowledge about the ultrasonic patterns of this kind of disease, misdiagnosis frequently happens. Reviewing the cases and relevant researches was helpful to understand the disease and figure it out in ultrasonic images. Methods Six cases of patients with dissecting leiomyoma were reviewed which were hospitalized in Beijing Obstetrics and cotyledonoid Gynecology Hospitalduring 2011 to 2016. All of the patients underwent ultrasound examinations before surgery. The ultrasound findings, clinical presentations and pathological features of the 6 patients were evaluated. Results In 6 patients with CDL, 5 cases were typical intramural dissecting leiomyomas, the inhomogeneous solid masshad irregular boundaries with muscle, color Doppler revealed intenseblood flow signals in the mass. One case exophytic component was in continuity with a lobulated, multinodular myometrial tumor with an irregular border, resembling cotyledon of the placenta. Conclusions Cotyledonoid dissecting leiomyoma was found to be inhomogeneous solid masswith irregular boundariesin some cases, exophytic component was multinodular myometrial tumor, resembling cotyledon of the placenta. Due to bizarre, sarcoma-like gross appearances. Thusit is hard to be diagnosed before surgery by ultrasonography, this type of lesion should be subjected tocareful ultrasonic examination in order to avoid over treatmentand preserve the fertility in young women.