卵巢硬化性间质瘤CT和MRI表现与病理特征

CT and MR features and pathological characteristics of ovarian sclerosing stromal tumor

目的探讨卵巢硬化性间质瘤的CT、MRI表现及其病理特征。方法选取经手术和病理证实的卵巢硬化性间质瘤9例患者临床资料,观察肿瘤的大小、形状、边缘、密度或信号及强化表现。结果9例均为单发,肿瘤最大直径3.5~12.0 cm,平均(6.6±2.9)cm。肿瘤呈卵圆形5例,圆形3例,分叶状1例。CT平扫显示肿瘤界限均清楚,其中实性肿块1例,密度均匀,界限清楚,密度与子宫相近,CT值41 HU;囊实性肿块4例,内部密度不均匀,CT值16~39 HU。MRI平扫显示肿瘤均呈囊实性,其中3例肿瘤内部信号混杂,T1Wl呈等信号,T2WI呈高及等信号,瘤内见“湖岛征”;1例肿瘤在T1Wl呈等信号,实质部分呈短T2、囊性部分呈长T2信号,内壁见结节、乳头状影,局部呈“毛刷”、“梳征”样改变。包膜在T1WI及T2WI均呈低信号。增强动脉期见肿瘤外周呈花环样、乳头状或梳齿状强化,静脉期、延迟期肿瘤实性部分渐进性、向心性强化,呈“快进慢出”为特征。病理检查9例均可见假小叶结构、印戒细胞、致密胶原纤维、疏松水肿结缔组织及丰富血管。结论CT和MRI检查对术前诊断卵巢硬化性间质瘤具有较高临床价值。

Objective To investigate CT and MR manifestations and pathological characteristics of ovarian sclerosing stromal tumor(OSST).Methods The clinical,pathological,CT and MRI data of 9 cases of OSST confirmed by surgery and pathology were retrospectively analyzed.The size,shape,edge,density or signal and enhancement of tumors were mainly observed.ResultsAll of the seven patients were solitary,and the maximum diameter was 3.5~12.0 cm,with an average of(6.6±2.9)cm.There were 5 cases of ovum,3 cases of round,and 1 case of lobes.CT plain scanning showed the edge of all the tumors was clear.There was 1 case of solid mass with limpid boundary and uniform density which was similar to the uterus with a CT value of 41 HU.There were 4 cases of solid-cystic mass with nonuniform density with a CT value of 12~36 HU.MRI plain scanning showed all the tumors were solid-cystic.The signal of tumors in 3 cases were mixed with T1WI of equal signal and T2WI of high and equal signal on which they showed like“Lake Island sign”.One case of tumor showed equal signal in T1WI,and the solid part of tumor showded short T2 signal,and the cystic part showed long T2 signal.Node and papillae could be seen in its inner wall with the shape of“brush”and“comb”locally.The capsule showed low signal on both T1WI and T2WI.CT and MRI enhancement scanning showed the edge of tumor had obviously enhancement with the shape of garland,palilla or comb in the arterial phase,and the solid part of the tumor had progressive and centripetal enhancement in the venous and the delayed phase,which was characterized by“fast wash-in and late wash-out”.Pathologic examination in 9 cases demonstrated pseudolobule patterns,signet-ring cells,collagenous areas,edematous hypocellular areas and prominent vasculatures.Conclusion Most of CT or MRI manifestations of OSST are characteristic,indicating that CT or MRI examinations are of high value for accurate preoperative diagnosis.