成人型卵巢颗粒细胞瘤影像学表现及鉴别诊断

Imaging Features and Differential Diagnosis of Adult Granulosa Cell Tumor of Ovary

目的:分析成人型卵巢颗粒细胞瘤的影像学表现及鉴别诊断方法。方法:回顾性分析7例经手术病理证实的成人型卵巢颗粒细胞瘤患者的临床及影像学资料,总结其影像学特点并与其他疾病鉴别。结果:7例病灶均单侧发病,右侧5例,左侧2例。囊实性5例,囊性为主1例,实性为主1例。(1)实性为主病灶:左侧附件区边界清晰实性病灶夹杂出血灶及小囊性灶,实性成分轻中度强化,同侧卵巢血管增粗。(2)囊性为主病灶:子宫前方单房厚壁囊性灶,囊外壁光整,内壁不规则增厚并多发乳头状结节,囊壁及结节轻中度强化。(3)囊实性病灶:3例病灶局限于盆腔内,2例病灶体积巨大向上突入腹腔。表现为实性病灶内夹杂多发囊性灶及出血灶,呈“蜂窝征”,4例可见液-液平,病灶实性成分不同程度强化。子宫增大4例,子宫内膜增厚5例,子宫平滑肌瘤3例,宫颈纳式囊肿4例,腹盆腔少量积液3例。结论:卵巢颗粒细胞瘤少见,容易和其他盆腔良恶性肿瘤混淆,CT和磁共振检查结合雌激素活性检测有助于鉴别诊断。

Objective:To evaluate the imaging features and differential diagnosis of adult granulosa cell tumor(GCT)of ovary.Methods:Clinical and imaging data of 7 patients with GCT proved by surgery and pathology were reviewed retrospectively.The imaging characteristics were summarized and differentiated it from other diseases.Results:All of lesions were unilateral,with 5 on the right and 2 on the left.The lesions were cystic-solid in 5 cases,cystic and solid in 1 case respectively.①Solid lesion:a well-defined solid mass with a few hemorrhagic foci and small cystic foci was seen in the left ovarian.After enhancement,the solid parts of the lesion were mild to moderate enhancement.The left ovarian vessels were thickened.②Cystic lesion:a single-locular,thick-walled cystic lesion was found in the front of the uterus,the outer wall of which was smooth and the inner wall was irregularly thickened with multiple papillary nodules.Capsular wall and papillary nodules were mildly to moderately enhanced.③Cystic-solid lesion:3 cases were confined to the pelvic cavity,2 cases were large and protruded upward into the abdominal cavity.Solid masses with multiple hemorrhagic foci and cystic foci with“honeycomb sign”were discovered.Bleeding signals were found in the cysts in 4 cases with liquid-liquid plane.The solid parts were enhanced in different degrees after injecting contrast agent.Uterine enlargement,endometrial thickening,uterine leiomyoma and cervical Narcini cyst were found in 4,5,3 and 4 cases respesctively.Small amount of abdominal and pelvic effusion was found in 3 cases.Conclusion:GCT of ovary is rare and easily confused with other pelvic benign and malignant tumors.CT and MR combined with estrogen activity tests are helpful in the differential diagnosis.