子宫内膜间质肉瘤的影像表现

Imaging manifestations of endometrial stromal sarcoma

目的:总结分析子宫内膜间质肉瘤的影像表现。方法:回顾性分析20例经手术及病理证实的子宫内膜间质肉瘤患者的临床及影像资料,并与病理结果对照分析。结果:20例子宫内膜间质肉瘤均经病理证实,其中低级别子宫内膜间质肉瘤11例,低级别子宫内膜间质肉瘤局部伴性索间质样分化1例,高级别子宫内膜间质肉瘤6例,低级别混合性子宫内膜间质-平滑肌肿瘤1例,未分化子宫内膜肉瘤1例。20例均为单发,其中腔内生长型6例,肌层肿块型7例,肌层浸润型3例,浆膜下型3例,宫外型1例。病灶最大径为(6.18±1.34)cm;类圆形14例,形态不规则6例;边界清晰8例,边界不清12例。12例出现卵石征,8例可见黏液样变区域,1例呈环岛征改变,7例肿块周围及内部见多发蚯蚓状、螺旋状强化血管影,6例瘤周可见T 2WI线状低信号轮廓,6例瘤周可见T 2WI结节状或蠕虫状稍高信号。增强扫描20例肿块实性成分呈渐进性、持续性强化,其中15例强化程度与子宫肌层相仿或高于肌层,5例强化程度低于肌层。结论:子宫内膜间质肉瘤的影像表现具有一定特征性,能为该病的诊断提供依据。

Objective:To summarize and analyze the imaging manifestations of endometrial stromal sarcoma(ESS).Methods:The clinical and imaging data of 20 ESS patients confirmed surgically and pathologically were retrospectively analyzed and then compared with pathological data.Results:There were 11 cases of low-grade ESS,1 case of low-grade ESS accompanied with sex cord stromal differentiation,6 cases of high-grade ESS,1 case of low-grade mixed ESS and smooth muscle tumor,and 1 case of undifferentiated ESS.The 20 patients were all with single lesion,including 6 cases of intracavitary growth,7 cases of muscular masses,3 cases of muscular infiltration,3 cases of subserosal tumors,and 1 case of the ectopic tumor.The focal maximum-diameter was(6.18±1.34)cm.There were 14 cases of round-like focus,6 cases with irregular morphology,and 8 cases with clear boundary and 12 cases with unclear boundary.Twelve cases were found with a cobble-stone sign,and eight cases with mucoid degeneration.One case was found with island-like sign alteration,7 cases with peripheral and internal multiple earthworm-like or spiral reinforced vascular shadows in masses,6 cases with peri-tumor T 2WI linear hypointensity outlines,and 6 cases with peri-tumor T 2WI nodular or slight vermicular hyperintensity.The solid components in the all 20 lesions were progressively and persistently enhanced.The enhanced degrees in 15 cases were equal to or higher than the muscular layer,while the enhanced degrees of the other five patients were lower than the muscular layer.Conclusion:The imaging manifestations of ESS display specific characteristics that can help to diagnosis.