卵巢支持-间质细胞肿瘤患者的CT影像特征及病理学特点

CT imaging characteristics and pathological characteristics of patients with Sertoli-Leydig cell tumors

目的探究卵巢支持-间质细胞肿瘤(SLCT)患者的CT影像特征,并分析其病理学特点。方法回顾性分析2015年6月至2021年6月西安市第九医院经手术病理证实的12例SLCT患者的一般临床、病理及影像学资料,分析患者的CT影像特征和临床病理学特点。结果12例SLCT患者,4例表现为绝经后出血、腹胀,3例存在附件包块,2例出现男性化症状,3例表现为月经紊乱。所有患者血清睾酮水平均升高,4例患者雌二醇水平升高,FIGO分期均为Ⅰa期。CT平扫显示,所有患者均为单发肿瘤,包括左侧7例,右侧5例;肿瘤横断面大小为4.2 cm×3.7 cm~12.5 cm×11.3 cm;9例呈囊实性肿块,3例呈实性肿块;肿块边界清晰,密度不均匀,囊壁可见钙化。增强扫描显示,囊壁、肿瘤实性成分呈进行性、明显强化或中度强化,囊内无强化,可见同侧卵巢静脉明显迂曲、增粗。病理检查结果显示,肿瘤呈圆形或卵圆形,表面存在纤维包膜,切面呈黄白色,共诊断高分化2例,中分化4例,低分化4例。免疫组化检测结果显示,Inhibin-α(+)12例,Vimentin(+)10例,Calretinin(+)4例,Ki67(+)5例,CK7(+)2例。结论SLCT患者的CT表现存在一定特征,多表现为单侧囊实性或实性肿块,肿块边界清晰,密度不均匀,囊壁可见钙化,实性成分呈进行性中度或明显强化,结合临床病理特征及免疫组化结果可提高临床诊断准确率。

Objective To explore CT imaging characteristics of patients with Sertoli-Leydig cell tumors(SLCT),and to analyze their pathological characteristics.Methods The generally clinical,pathological and imaging data of 12 patients with SLCT confirmed by surgical pathology in Xi’an Ninth Hospital between June 2015 and June 2021 were retrospectively analyzed.CT imaging characteristics and clinicopathological characteristics of the patients were analyzed.Results Among the 12 SLCT patients,there were 4 cases with postmenopausal bleeding and abdominal distension,3 cases with adnexal tumors,2 cases with virilizationsymptoms,and 3 cases with menstrual disorders.The level of serum testosterone in all patients was increased.There were 4 patients with increased estradiol,and FIGO staging was stageⅠa.CT plain scan showed that all patients were accompanied with single tumor,including 7 cases on the left side and 5 cases on the right side.Cross-sectional size of the tumor was 4.2 cm×3.7 cm to 12.5 cm×11.3 cm.There were 9 cases with cystic solid masses and 3 cases with solid mass,with clear boundaries,uneven density and calcification in cyst walls.The enhanced scan showed that cyst walls and solid components of tumors showed progressive,significant or moderate enhancement.There was no enhancement inside the cysts.The ipsilateral ovarian veins were significantly tortuous and thickened.Pathological examination results showed that the tumors were round or oval,with fibrous capsules on their surface.The section plane was yellow-white.There were 2 cases with high differentiation,4 cases with moderate differentiation and 4 cases with low differentiation.The results of immunohistochemistry showed that there were 12 cases with Inhibin-α(+),10 cases with Vimentin(+),4 cases with Calretinin(+),5 cases with Ki67(+),and 2 cases with CK7(+).Conclusion There are certain characteristics of CT findings in SLCT patients,most are characterized by unilateral cystic solid or solid masses with clear boundaries,uneven density and calcification in cyst walls.The solid components show progressive,moderate or significant enhancement.The combination of CT imaging characteristics with clinical pathological characteristics and immunohistochemistry results can improve the accuracy rate of clinical diagnosis.