绝经后女性卵巢甲状腺肿的超声表现并文献复习

Ultrasonographic findings of struma ovarii in post-menopausal women and a literature review

目的探讨绝经后女性卵巢甲状腺肿(PMSO)的超声影像学临床特征。方法.回顾性分析经手术病理证实的7例PMSO患者的临床、经阴道超声(TVS)资料,并与病理结果进行对照分析。结果7例PMSO患者年龄52~77(60.1±8.0)岁,中位年龄59岁,自然绝经年龄(49.9±1.8)岁,超声影像学资料附件区肿物均为单侧(左侧1例,右侧6例)。病灶形态不规则,或呈类圆形、椭圆形,边缘清晰或不清晰,大小2.8~9.5cm。2例超声诊断为畸胎瘤,呈混合回声,内有无回声区,透声差,彩色多普勒超声混合回声内部及周边可见或不见血流信号。5例超声误诊,其中2例超声误诊为老年卵巢子宫内膜异位囊肿,3例超声误诊为卵巢囊腺癌。均行手术治疗,术后恢复良好,至随访结束7例患者均未见卵巢甲状腺肿复发。结论PMSO是罕见的单胚层畸胎瘤,易误诊,需与绝经后卵巢子宫内膜异位囊肿、成熟畸胎瘤、卵巢囊腺癌等鉴别。肿块>5cm超声表现可能有一定特征性,包括甲状腺肿突起、囊壁钙化等。囊实性包块中实性部分伴有血流,可提示卵巢甲状腺肿诊断。

Objective To examine the ultrasonographic and clinical features of post-menopausal struma ovarii(PMOS).Methods Clinical presentations and transvaginal sonography(TVS)data of 7 PMOS patients diagnosed during surgery were retrospectively analyzed and compared with histopathological results.Results The ages of 7 patients ranged from 52 to 77 years(60.1±8.0 years,median age:59 years,natural menopause age:49.9±1.8 years).Ultrasound imaging data showed all adnexal masses were unilateral(1 on the left side,6 on the right side).The focal lesions were irregular,round or elliptic in shape,measuring 2.8-9.5 cm,with either clear or unclear margins.Two PMSO cases were diagnose as teratoma on ultrasound,showing mixed echogenic patterns,with echoless interior regions and poor sound transmission.Color doppler flow imaging found no blood flow signal inside and around the mixed echogenic areas.Five cases were misdiagnosed on ultrasound,with 2 as postmenopausal ovarian endometrial cyst and 3 as ovarian cystadenocarcinoma.All patients recovered well after surgery.By the end of the follow-up,nc recurrence of struma ovarii was found in the 7 cases.Conclusions PMSO is a rare monodermal teratoma,can be easily misdiagnosed and needs to be differentiated from postmenopausal ovarian endometrial cyst,mature teratoma,ovarian cystadenocarcinoma and other types of lesions.A mass>5 cm may exhibit characteristic ultrasonographic manifestations,including protruding thyroid nodules,cyst wall calcification,etc.A solid portion of the cystic mass with blood flow may suggest a diagnosis.of struma ovarii.