腹膜后平滑肌肉瘤的临床、CT表现及病理分析

The Clinical,CT and Pathological Analysis of Retroperitoneal Leiomyosarcoma

目的探讨腹膜后平滑肌肉瘤的临床、影像学和病理学表现,提出诊断和鉴别诊断要点,以提高对本病的认识。方法回顾性分析11例经手术病理证实的腹膜后平滑肌肉瘤患者的临床资料,并结合相关文献分析。结果 7例病灶位于下腔静脉右前方,3例位于腹主动脉左前方,1例位于盆腔内;8例形态不规则,3例呈椭圆形;6例侵犯下腔静脉,8例侵犯周围脏器,3例肝转移;平扫10例密度不均匀,中心可见坏死囊变;动态增强扫描,实质成分均呈进行性持续强化,囊变坏死区无强化;2例可见钙化灶。镜下肿瘤细胞呈梭形,细胞异型性明显,核分裂像多见,可见局灶坏死。结论腹膜后平滑肌肉瘤较少见,临床表现不典型,CT表现具有一定的特征性,最终仍需病理确诊。

Objective To investigate the clinical,imaging and pathological manifestations of retroperitoneal leiomyosarcoma,and to make a diagnosis and differential diagnosis in order to improve the understanding of the disease.Methods The clinical data of 11 patients with retroperitoneal leiomyosarcoma with surgical pathology were analyzed retrospectively,And make an analysis with relative literature.Results Seven cases were located in the right front of the inferior vena cava,and 3 cases were located in the front of the abdominal aorta and 1 cases in the pelvic cavity.The 8 cases were irregular in shape,and the 3 cases were elliptic.6 cases with invasion of inferior vena cava,8 cases of peripheral organs,3 cases of liver metastasis.In the 10 cases,the density was not uniform and the necrosis cyst was seen in the center.In the dynamic enhancement scanning,the essential components showed progressive and continuous enhancement,and the cystic necrosis region was not enhanced.2 cases of calcified lesions were seen.Pathological examination demonstrated spindleshaped tumor cells with significant heteromorphism.Conclusion The retroperitoneal leiomyosarcoma is rare and its clinical manifestation is atypical,the CT performance has certain characteristic,but the final diagnosis still needs pathology.