宫颈绒毛管状腺癌的影像学表现及临床因素分析

Imaging findings and clinical factor analysis of cervical villoglandular adenocarcinoma

目的:系统分析宫颈绒毛管状腺癌影像学表现及其临床相关特点。方法:选取宫颈绒毛管状腺癌34例,其中20例有超声检查结果,16例有CT检查结果,13例有MRI检查结果。结果:宫颈绒毛管状腺癌患者较年轻,临床症状多为阴道不规则流血,多伴有人乳头瘤病毒(human papillomavirus,HPV)感染。宫颈绒毛管状腺癌超声表现为低回声或混合回声肿块,形态较规则,边界清晰,偶尔可见少许血流信号。CT上,多表现为宫颈形态改变,平扫时宫颈平均CT值比正常宫颈、鳞癌低(P<0.05),与普通型宫颈腺癌相比差异无统计学意义(P>0.05)。MRI上,肿块平均体积比普通型腺癌、鳞癌小,差异有统计学意义(P<0.05);宫颈间质及宫旁浸润情况较普通型腺癌、鳞癌为好。结论:宫颈绒毛管状腺癌临床表现缺乏特征性,超声、CT、MRI能提供形态学和解剖学信息,MRI可准确地判断宫颈病灶及宫旁受累情况,提高术前诊断准确性,从而优化治疗。

Objective： To systematically analyze the clinical data of villoglandular adenocarcinoma（VGA） of the cervix and its imaging performance. Methods： A total of 34 cases of cervical VGA were chosen. There were 20, 16, 13 cases with ultrasound, CT and MRI data, respectively. Results： The patients of cervical VGA was younger and the main clinical symptom was irregular vaginal bleeding. Most cases were associated with human papillomavirus（HPV） infection. The performance of cervical VGA on ultrasound was characterized by hypoecho or mixed echo mass, regular morphology, clear boundary, and occasional blood flow signals. On CT, cervical VGA mainly shows the changes in cervical morphology. The average CT value of cervical VGA was lower than normal cervix and squamous cell carcinoma（P〈0.05）, but there was no statistically significant difference compared with common type of cervical adenocarcinoma（P〉0.05）. On MRI, the average volume of cervical VGA masses was smaller than common adenocarcinoma and squamous cell carcinoma（P〈0.05）. The status of cervical interstitial and uterine infiltration in cervical VGA was better than common adenocarcinoma and squamous cell carcinoma. Conclusion： Cervical VGA is lack of special clinical manifestations. Ultrasound, CT and MRI can provide morphological, anatomical, and functional information. MRI can accurately determine cervical lesions and involvement to improve the accuracy of preoperative diagnosis and choose optimized treatment.