58例坐骨直肠窝肿瘤患者的临床特点及影像学资料分析

Clinical characteristics and imaging data of ischiorectal fossa tumors:a series of 58 cases

目的坐骨直肠窝肿瘤少见,其误诊率高,关于坐骨直肠窝肿瘤患者临床症状、体征及诊疗的报道较少。本文以本中心收治的58例原发性坐骨直肠窝肿瘤患者为例,重点分析此类患者的临床特点及影像学资料,旨在为临床诊疗提供参考。方法选取2013年7月至2021年7月于中山大学附属第六医院确诊原发性坐骨直肠窝肿瘤并接受切除手术的58例患者为研究对象,所有患者术前均进行盆腔增强MRI检查,部分患者进行胸部+腹部+盆腔增强CT检查、PET/CT检查。汇总、分析患者的一般资料,临床症状、体征、体格检查结果,影像学资料,术后病理结果等临床资料。结果在58例患者中,男性12例、女性46例,中位年龄为38.0(29.8,51.2)岁,从出现临床症状至疾病确诊的中位时间间隔为7(2,13)个月;48例患者的肿瘤最大径>5 cm;18例患者既往被误诊;20例患者既往接受不同类型的手术治疗。恶性肿瘤患者相对年长且均存在临床症状,患者初次就诊时局部凸起更常见且术前影像的肿瘤最大径相对更大;良性肿瘤患者则多以会阴部钝性疼痛为主要症状就诊。恶性肿瘤在MRI上多为实性病灶,信号强度不均匀,边界不规则而有浸润且注射造影剂后有强化表现;其中,1例恶性肿瘤患者术前MRI检查结果提示囊性病变,术后病理结果为黏液腺癌。术前MRI、CT检查对于肿瘤性质的影像学诊断结果与术后病理诊断结果的一致性较好(Kappa值分别为0.713、0.635)。结论根据患者的临床特点与影像学特征可对坐骨直肠窝肿瘤的性质进行初步的判断,年龄偏大、存在临床症状、可见局部凸起、增强MRI影像提示非囊性病灶或病灶有强化的患者需要高度警惕罹患恶性肿瘤的可能。

Objectives Ischiorectal fossa tumors are rare and have a high misdiagnosis rate,and limited reports discuss clinical symptoms,signs,treatments and diagnoses.This study focuses on the clinical characteristics and imaging data of 58 patients with primary ischiorectal fossa tumors receiving treatments at our center,aiming to provide references for clinical treatments and diagnoses.Methods Fifty-eight patients who underwent resection surgery for primary ischiorectal fossa tumors at The Sixth Affiliated Hospital,Sun Yat-sen University from July 2013 to July 2021 were studied.All patients had pelvic enhanced MRI,and some had had chest+abdomen+pelvic enhanced CT and PET/CT examination.Patient’s general information,clinical symptoms,signs and results of physical examination,imaging data,postoperative pathological results were collected and analyzed.Results Among the 58 patients,12 were male and 46 were female,with a median age of 38.0(29.8,51.2)years.The median time from symptom onset to diagnosis was 7(2,13)months.Maximum tumor diameter in 48 patients was>5 cm.Eighteen had a history of misdiagnosis,and 20 had previous surgeries.Malignant tumor patients were older,preseneted clincal symptoms,more likely to have local protrusions at initial visits,and had larger maximum tumor diameter on preoperative imaging.Benign tumor patients often complained of perineal dull pain.Malignant tumors on MRI showed solid lesions with uneven signal intensity,irregular boundaries,invasion,and post-contrast enhancement.Among them,preoperative MRI examination of one patient with malignant tumor suggested cystic lesion,but postoperative pathological diagnosis revealed mucinous adenocarcinoma.MRI and CT imaging diagnoses were consistent with postoperative pathological diagnosis(Kappa values were 0.713 and 0.635,respectively).Conclusion Ischiorectal fossa tumor nature can be initially determined based on clinical characteristics and imaging features.Older patients with clinical symptoms,visible local protrusions,and enhanced MRI suggesting non-cystic lesions or lesions with enhancement should be highly suspicious of malignancy.