25例卵巢甲状腺肿经阴道超声特征分析

Transvaginal Ultrasonographic Characters Analysis of 25 Cases of Struma Ovarii

目的探讨经阴道超声在卵巢甲状腺肿(SO)临床诊断中的价值。方法回顾性分析某院于2014年1月1日-2019年10月31日收治的手术病理证实为SO的25例患者的经阴道超声(TVS)结果及临床资料,结合病理诊断进一步分析超声影像学特征。结果 25例患者的平均年龄为39.1±15.2岁(17岁~77岁),均无明显临床症状,其中3例未婚。TVS检查出附件区病灶28处,漏诊1处卵巢内小于1cm的病灶,术后病理证实为囊性成熟畸胎瘤。25处病理证实为SO病灶的大小为3.3cm^11.6cm,48%(12/25)TVS声像为无回声,其中5处透声尚好,7处无回声内见散在点状强回声及分隔,彩色多普勒(CDFI)显示内部及周边未见明显血流信号。20%(5/25)TVS呈现较特异的畸胎瘤声像,12%(3/25)TVS有面团征,4%(1/25)TVS有壁立结节征后伴声影,4%(1/25)TVS有脂液分层征,CDFI内部及周边均未见明显血流信号。32%(8/25)TVS为囊实性包块,CDFI实性部分见/未见明显血流信号。25例SO患者均为良性病例,均为单侧SO,声像图表现均为边缘清晰,呈类圆形、椭圆形或不规则形囊性或囊实性包块,内有分隔,呈多房性,囊内有中高回声突起存在,CDFI显示部分分隔及实性成分中见血流信号。结论 SO发病率低、超声表现多样化,临床表现不特异,容易与卵巢子宫内膜异位囊肿、囊腺瘤、其他类型畸胎瘤及卵巢癌混淆,单侧肿块呈多房囊性或囊实性,边界清晰,囊内见结节状中等或中高回声同时伴血流信号,应考虑SO的可能。

Objective To explore the value of transvaginal ultrasound in the clinical diagnosis of struma ovarii(SO). Methods Retrospective analysis of transvaginal sonography(TVS) results and clinical data of 25 SO patients confirmed by surgery and pathology was conducted in a hospital from January 1 st, 2014 to October 31 st, 2019, and the ultrasonic imaging characteristics were further analyzed combined with pathological diagnosis. Results The mean age of the 25 patients was 39.1±15.2 years(17-77 years), no obvious clinical symptoms were observed,three of the cases were unmarried.TVS detected 28 lesions in the accessory region, and missed 1 lesion less than 1 cm in the ovary, which was confirmed as cystic mature teratoma by pathology after surgery.The size of 25 SO lesions was confirmed by pathology ranging from 3.3-11.6 cm, 48 %(12/25)TVS sound image is non-echo: 5 of them echo is good, 7 of them have scattered strong echo and separation, color doppler flow imaging(CDFI) shows no obvious blood flow signal inside and around. 20%(5/25)TVS presented a more specific image of teratoma :12%(3/25)TVS had a dough sign, 4%(1/25)TVS had a wall tuberosity sign followed by shadow, and 4%(1/25)TVS had a lipid-liquidstratification sign, CDFI showed no obvious blood flow signal inside and around. 32%(8/25) TVS were cystic solid masses, and significant blood flow signal was seen/not seen in solid part with CDFI. All the 25 SO patients were benign cases, all of them were unilateral SO, and the sonogram showed clear edges, like round, oval or irregular cystic or cystic solid mass, with compartments and multiloculated. There were medium and high echo projections in the capsules, and blood flow signals could be seen in some compartments and solid components with CDFI. Conclusions SO low incidence, diversification of sonographic findings, clinical manifestation was not specific, easily confusion with ovarian endometriosis cyst, cystadenoma, other types of teratoma and ovarian cancer, the unilateral mass was multilocular cystic or cystic solid, with a clear boundary, nodules of medium to high echo accompanied by blood flow signal could be seen in the cyst, SO should be considered.