卵巢透明细胞癌的临床、实验室检查、CT和MRI表现

Clinical and Laboratory Examinations,CT and MRI Findings of Ovarian Clear Cell Carcinoma

目的探讨卵巢透明细胞癌（OCCC）的临床、实验室检查及CT和MRI表现。方法回顾性分析2013年1月至2016年2月间确诊的OCCC患者相关病史资料。临床表现包括年龄、月经状况、就诊症状及合并症;实验室检查包括CA125、CA199及血钙水平;CT及MRI表现主要分析病灶发生部位、数量、大小、成分、增强表现及周围淋巴结等合并表现。结果共纳入32例OCCC患者,共34个肿瘤病灶。其中,CT组和MRI组各16例,各发现17个病灶。56.3%（18/32）患者处于绝经期,59.4%（19/32）患者合并子宫内膜异位,腹痛、腹部包块及其他合并症发生率均未达50%。实验室检查只有1例（3.1%）患者血钙过高;43.8%（14/32）和59.4%（19/32）患者CA199和CA125增高。CT和MRI表现主要为单侧（93.8%,30/32）、类圆形（73.5%,25/34）、边界清楚（85.3%,29/34）、包膜完整（94.1%,32/34）、单房（73.5%,25/34）、囊性（47.1%,16/34）或囊实性（47.1%,16/34）肿块。64.7%（22/34）的病灶合并壁结节,67.6%（23/34）肿块内实性成分呈偏心生长,97.1%（33/34）实性成分增强扫描后呈持续性不均匀强化,m ADC值为（0.79±0.11）×10^（-3）mm^2/s,min ADC值为（0.88±0.09）×10^（-3）mm^2/s。82.4%（14/17）病灶中囊性成分与尿液CT值之比≥1,76.5%（13/17）病灶囊性成分T_1WI信号强度高于尿液信号强度。CT与MRI两组资料及基本影像表现间差异无统计学意义（P〉0.05）。结论OCCC患者常处于绝经期合并卵巢子宫内膜异位,CA199、CA125或血钙轻度升高,影像学发现单侧类圆形、少分隔、较大的囊实性或囊性肿块,实性成分为持续不均匀明显强化的附壁结节或乳头状突起。囊性成分CT值和MRI信号强度增高,对诊断有重要提示作用。

Objective To investigate the clinical and laboratory examinations,CT and MRI findings of ovarian clear cell carcinoma（OCCC）.MethodsRetrospectively analyzed the histories of OCCC patients from January 2013 to February2016,the clinical manifestations including age,menstrual conditions,symptoms and complications.The laboratory examinations were the serum level of CA125,CA199 and calcium;CT and MRI findings mainly recorded the focal area,number,size,compositions,enhancement performance,peripheral lymph nodes and so on.Results 32 OCCC patients were enrolled,and we found 34 tumor lesions.CT and MRI group each had 16 patients,and found 17 lesions.56.25%（18/32）of the patients were menopause,59.38%（19/32）combined with endometriosis,but the rate of abdominal pain,abdominal masses and other complications were less than 50%.Only 1（3.13%）case was hypercalcemia,the level of CA199and CA125 in 47.35%（14/32）and 59.38%（19/32）patients were higher than the normal.The main performances in imaging were unilateral（93.75%,30/32）,oval（73.53%,25/34）,well-defined（85.29%,29/34）,with intact capsule（94.12%,32/34）,single cavity（75.53%,25/34）,cystic（47.06%,16/34）or solid-cystic（47.06%,16/34）masses.64.71%（22/34）of the lesions had mural nodules or papillary projections,the solid components of 67.65%（23/34）lesions grew eccentrically,97.06（33/34）solid components showed continuous inhomogeneous enhancement.The m ADC value was（0.79±0.11）×10^（-3）mm^2/s,min ADC was（0.88±0.09）×10^（-3）mm^2/s.In 82.35%（14/17）lesions,the CT values of the cystic components vs the bladder≥1,the cystic components of 76.47%（13/17）lesions had higher signal intensities than the bladder on T_1WI.The clinical and imaging differences between CT and MRI were not statistically significant（P〉0.05）.Conclusion OCCC patients were usually menopause with endometriosis,increased CA199 and CA125level or calcium;CT and MRI imagings found unilateral,oval and big solid-cystic or cystic masses with intact capsule,solid components had mural nodules or papillary projections which showed continuous inhomogeneous enhancement.The CT values or MRI intensities of cystic components which were higher than the bladder were important for diagnosis.