卵巢透明细胞癌的CT表现

CT Manifestation of Ovarian Clear Cell Carcinoma

目的探讨卵巢透明细胞癌（OCCC）的CT表现特征。方法回顾性分析11例病理证实的OCCC患者CT平扫和增强资料,着重分析肿瘤的位置、数目、大小（最大层面直径）、形态、边缘、包膜、分隔、坏死、钙化、囊实性肿块特征、囊壁厚薄、囊性成分密度、实性成分的形态及其强化方式。结果 11例OCCC均为单侧囊实性肿块,肿瘤平均最大直径为13.6 cm（7.4-35 cm）。圆形3例,椭圆形8例,均为单房,边界清晰9例,部分边界模糊2例;薄壁8例,部分囊壁增厚3例。囊性部分密度均匀,CT值平均24 HU（16-28 HU）。偏侧壁均伴有形态不一的实性成分,实性部分平均最大直径3.5 cm（1.6-7.1 cm）,呈乳头状4例,实性结节2例,实性肿块5例;7例伴坏死。增强扫描囊性部分无强化,实性部分呈持续强化趋势,实质期强化程度高于动脉期,坏死区无强化,部分增厚的囊壁延迟强化。伴有钙化1例,骨化1例,2例伴有盆腔少量积液,3例伴有盆腔淋巴结肿大。结论肿块较大、边界清晰、单房囊实性肿块、相对高密度囊腔、偏侧壁突出的实性肿块、实性部分伴有坏死,增强后渐进性持续强化是OCCC相对典型的CT表现。

Objective To evaluate the CT findings in patients with clear cell carcinoma of the ovary. Methods CT Data of eleven patients with pathologically proved ovarian clear cell carcinoma were retrospectively reviewed. All patients underwent preoperative plain and contrast-enhanced scan. CT findings were evaluated for the laterality,number,size（ maximal transverse diameter）,margin,edge,encapsulation,separation,necrosis,calcification,cystic-mass characteristic,cystic wall thickness,attenuation of the cystic portion,form of solid components and enhancement pattern. Results Tumors were unilateral and cystic masses with solid regions in 11 patients. The mean maximal transverse diameter was 13. 6 cm（ range7. 4 cm to 35 cm）,the lesions were round mass（ n = 3）,oval mass（ n = 8）,unilocular（ n = 11）,smooth margin（ n = 9）,partial fuzzy boundary（ n = 2）,thin cystic wall（ n = 8）,partly cystic wall thickness（ n = 3）. The cystic portion of the masses were homogeneous and average attenuation was 24 HU（ range 16 to 28 HU） on plain image. The lateral wall was accompanied by a solid component with different shapes,and the mean maximum diameter of the solid part was 3. 5 cm（ range 1.6 cm to 7. 1 cm）,including papillary（ n = 4）,solid nodules（ n = 2） and solid mass（ n = 5）,7 cases with necrosis in the 11 cases. On enhanced scan,the cystic part of the tumor had no enhancement,and the solid component of the tumor showed sustained enhancement trend. The degree of parenchymal enhancement was higher than that of arterial phase,no enhancement of necrotic part and cystic wall thickening of the tumor had delayed enhancement. Additionally,1 case possessed calcification,1 cases of ossification,2 cases with pelvic effusion,and 3 cases with pelvic lymph node enlargement. Conclusion OCCC typically presents as a large,well-defined,unilocular cystic mass,with solid projections and relatively highly attenuating cystic or necrotic portions and the solid component of tumor showed sustained enhancement trend.