黄色肉芽肿性女性生殖道炎症影像学表现并文献复习

Image Findings of Xanthogranulomatous Inflammation of Female Genital Tract and Literature Review

目的报道1例宫颈黄色肉芽肿性炎(XGI)并复习文献,提高对该病的认识。方法回顾性分析1例XGI宫颈炎合并弥漫大B细胞淋巴瘤患者的影像学表现,总结文献报道中XGI女性生殖道炎症的影像学特点。结果子宫内膜XGI,MRI示子宫增大,内膜增厚,T;WI脂肪抑制序列低信号,T;WI高信号。累及附件者单侧、多房囊性病变多见,CT增强扫描囊壁渐进性持续强化,囊壁内无强化结节状低密度影可提示诊断;MRI中囊壁T;WI低信号,T;WI高信号,扩散加权成像(DWI)囊壁扩散受限,内可见扩散不受限结节,增强后无强化。结论 XGI女性生殖道炎症有一定的影像学特征,累及附件者易于恶性肿瘤混淆,CT及MR尤其是DWI有一定的特征性;累及宫颈者推荐MRI评估;累及子宫内膜者影像学表现无特异性。

Objective Report a case of xanthogranulomatous inflammation of cervix, and improve the comprehension of these disease by reviewing the literature. Methods A case of xanthogranulomatous inflammation of cervix with lymphoma was retrospectively analyzed, and the imaging characteristics of genital tract inflammation in women with xanthogranulomatous were summarized. Results When the inflammation affected the endometrium, it showed bulky uterus and endometrial hyperplasia, high-intensity by T;-weighted imaging and low-intensity by T;-weighted(fat-suppressed) imaging.Unilateral, multilocular, cysticlesion with thick wall is more common with accessory involvement, progressive and continuous enhancement of the cystic wall on enhanced CT scanning, and non-enhancing intramural nodules inthe cystic wall may be suggestiveof the diagnosis. The intramural nodules were hypointense relative to the myometrium on T1-weighted images and hyperintense( similar to the intensity of water) on T2-weighted images;the nodules showed no enhancement after IV injection of gadopentetate dimeglumine,and show a low signal on DWI. Conclusion Xanthogranulomatous inflammation of the female genital tract is an unusual entity,and clinically forms mass-like lesions in the pelvic cavity that invades the surrounding tissues,which may mimic a tumor clinically,but the imaging findings arecharacteristic that the presence of non-enhancing intramural nodules in the thick wall of the lesion may be a unique MR indicator. MR is recommended for characterization of the cervical lesions. Further studies are needed on the imaging features ofxanthogranulomatous endometritis.