卵巢性索间质肿瘤的临床及超声表现分析

Clinical and sonographic features of ovarian sex cord stromal tumors

目的探索卵巢常见类型性索间质肿瘤的超声特点及其与临床表现的相关性,并分析误诊原因。方法收集2010年至2019年复旦大学附属中山医院经阴道及/或经腹部超声检查并经手术病理证实的71例卵巢性索间质肿瘤患者。卵泡膜纤维瘤、卵泡膜细胞瘤及纤维瘤属于卵巢纤维-卵泡膜瘤组(ovarian thecoma-fibroma groups,OTFG),共64例;成人颗粒细胞瘤(adult granular cell tumor,AGCT)共7例。收集患者卵巢肿块的最大径线、回声、形态、边界、后方回声是否衰减、彩色多普勒血流成像(color Doppler flow imaging,CDFI)信号等信息;比较不同大小肿瘤之间盆腔积液、CA125及肿瘤囊性成分是否具有差异;分析超声成像诊断符合率及误诊情况。结果OTFG多纵横比<1(89.1%),AGCT多为不规则形或分叶状(100%);OTFG以实质低回声为主(73.4%),AGCT常表现为囊实混合型(100%);68.8%OTFG病灶伴回声衰减,AGCT均不伴回声衰减;所有病灶边界清晰;OTFG病灶CDFI多表现为无或少量彩色血流信号,血流信号以周边多见(60.9%),AGCT则CDFI以3、4级彩色血流多见(100%)。不同大小肿瘤之间囊性成分、CA125及盆腔积液差异有统计学意义(χ^2=7.407、16.080和21.540;P=0.025、<0.001和<0.001)。实性及实性为主型病变诊断符合率高于囊实性及囊性为主型。结论 OTFG与AGCT在超声表现上有一定差异,可通过声像图特征对两组疾病进行鉴别诊断。

Objective To explore the sonographic characteristics of common ovarian sex cord stromal tumors and their correlation with clinical manifestations,and to analyze the causes of misdiagnosis.Methods Ultrasound data of 71 patients with ovarian sex cord stromal cell tumors who underwent transvaginal ultrasonography and confirmed by surgery and pathology from 2010 to 2019 in Department of Ultrasound,Zhongshan Hospital were enrolled in our study.Sixty-four cases of thecal fibroma,thecal cell tumor and fibroma were belong to ovarian thecoma-fibroma groups(OTFG),and 7 cases of adult granular cell tumor(AGCT).Ultrasound features including maximum diameter,echo,boundary,attenuation of posterior echo,color Doppler flow imaging(CDFI)were collected.The cystic components,pelvic fluid and CA125 were compared among different size.The coincidence rate and misdiagnosis of ultrasound imaging were analyzed.Results The longitudinal and transverse ratio of the most of OTFG were less than 1(89.1%),and most of AGCT were irregular or lobulated(100%).OTFG were predominantly hypoechoic(73.4%),and AGCT were often mixed with cystic solids(100%).68.8%of OTFG lesions were accompanied by echo attenuation,while AGCT were not.All lesions were well-defined.CDFI of OTFG lesions showed no or a small amount of color blood flow signal,and most of the blood flow signals were peripheral(60.9%).In AGCT,CDFI was more common in grade 3 and 4(100%).Different size of ovarian sex cord-stromal tumors masses were different in cystic components,pelvic fluid and CA125(χ~2=7.407,16.080,21.540;P=0.025,<0.001,<0.001).The coincidence rate of diagnosis of solid and solid predominant lesions was higher than that of cystic solid and cystic predominant lesions.Conclusion Ultrasound diagnosis of ovarian sex cord stromal tumors has some characteristic features,which can be used to differentiate the two groups of diseases.