儿童和青少年卵巢肿瘤及肿瘤样病变的临床及影像特征

Clinical and imaging features of ovarian tumors and tumor-like lesions in 74 children and adolescents

目的 :探讨儿童与青少年卵巢肿瘤及肿瘤样病变的临床及术前影像特征,提高其诊断水平。方法 :回顾性分析经组织病理学证实的74例20岁及以下卵巢肿瘤及肿瘤样病变患者的临床与影像资料。结果:74例76个病变,68个(89.5%)为良性,8个(10.5%)为恶性,恶性肿瘤患者年龄3～18岁。76个病变中,生殖细胞肿瘤38个(50.0%),其中8个恶性;其次为上皮性肿瘤20个(26.3%)和性索间质肿瘤3个(3.9%),其他病变15个。38个生殖细胞肿瘤,29个出现脂肪,28个出现钙化,3个成熟畸胎瘤出现壁结节。14例出现腹胀,2例为恶性肿瘤。37例出现腹部包块,6例为恶性肿瘤。8个恶性肿瘤中,2个hCG水平升高,6个AFP水平升高,1个卵黄囊瘤hCG和AFP水平同时升高。8个恶性肿瘤最大径> 12 cm,34个良性病变最大径> 12 cm。6个恶性肿瘤明显强化,12个良性病变中度强化。2个恶性肿瘤出现大量腹水。结论:生殖细胞肿瘤在儿童及青少年卵巢肿瘤中所占比例较高。钙化和脂肪为成熟畸胎瘤较特异的表现。hCG、AFP水平对于诊断恶性肿瘤有意义;最大径> 12 cm、富血供及大量腹水等特征提示恶性肿瘤。

Objective:To investigate the clinical characteristics and pre-operative imaging features of ovarian tumors and tumor-like lesions in children and adolescents to improve diagnostic level of them.Methods:A retrospective analysis of the clinical and imaging data was carried out in 74 patients(20 years or younger)with ovarian tumors and tumor-like lesions,confirmed by pathology.Results:Among 76 lesions in 74 patients,68 lesions(89.5%)were benign and 8 lesions(10.5%)were malignant,with age range from 3 to 18 years old in malignant lesions.38 lesions were germ cell tumors(8 malignant),followed by 20 lesions of epithelial tumors(26.3%)and 3 lesions of sex cord stromal tumors(3.9%).Among 38 germ cell lesions,fat and calcification were found in 29 and 28 lesions respectively,with mural nodules in 3 mature teratomas.Fourteen patients presented with abdominal distension(2 malignant)and 37 patients presented with palpable mass(6 malignant).Among 8 malignant tumors,hCG levels were increased in 2 cases,AFP levels were increased in 6 cases,and both hCG and AFP were simultaneously elevated in one case of yolk sac tumor.The largest diameter of all malignant tumors and 34 benign lesions were larger than 12 cm.Six malignant tumors showed remarkable enhancement and 12 benign lesions showed moderate enhancement.Voluminous ascites was found in 2 malignant tumors.Conclusions:Germ cell tumors account for a large percentage of ovarian tumors in children and adolescents.Fat and calcification are specific for mature teratoma.AFP and hCG level are helpful for the diagnosis of malignant tumor.Predictive factors for malignancy include tumors larger than 12 cm,tumoral hypervascularity and voluminous ascites.