妊娠合并恶性肿瘤的临床特征及影像学诊断价值

Preliminary study on clinical features and imaging diagnostic values of pregnancy associated malignancy

目的 探讨妊娠合并恶性肿瘤(PAM)的临床特征及影像诊断价值。方法 收集2010年1月—2020年12月影像归档和通信系统(PACS)的影像诊断报告中出现“妊娠合并肿瘤”关键字,且经手术或活组织检查(简称活检)病理证实为PAM的10例患者的临床资料,均为女性,年龄为(32.7±4.6)岁,接受治疗时妊娠时间为孕29周。患者于产前常规超声检查中发现异常(5例)和妊娠期间出现相关临床症状(5例)后行CT或MRI检查。分析患者的一般资料(孕母年龄、孕周、发现病变后治疗时间、分娩方式、胎儿结局等)、临床表现、产前超声诊断,以及乳腺X线摄片、CT及MRI检查结果,由2名经验丰富的影像科医师对影像资料进行分析,并进行影像学诊断。结果 10例PAM患者中,2例经诊断后引产;4例经诊断后提前终止妊娠,行剖宫产;4例经诊断后继续妊娠,其中3例于孕37~37+6周行剖宫产,1例因发生胎儿宫内窘迫而提前终止妊娠。10例PAM患者,产前行乳腺X线摄片检查2例,CT平扫2例,MRI平扫7例(其中1例右肺癌患者腹部冠状面MRI平扫时发现胸部异常后,加行胸部CT平扫)。2例患者产前乳腺X线摄片诊断为乳腺癌。1例患者腹部MRI平扫见右肺下叶肿块,两肺多发小结节,加行CT平扫,产前CT诊断为右肺癌,两肺弥漫转移结节;1例患者CT平扫示胃壁明显不均匀增厚。6例患者产前MRI诊断分别为胃及右中下腹恶性肿瘤、盆腔右侧附件囊腺癌可能大、右侧附件恶性肿瘤、升结肠恶性肿瘤、盆腔脂肪肉瘤可能大、腹腔转移小结节可能。10例PAM患者均经手术或活检,病理诊断分别为卵巢恶性肿瘤3例(胃印戒细胞癌伴右侧卵巢转移、右卵巢黏液性腺癌、右卵巢未成熟畸胎瘤各1例),乳腺浸润性癌2例,右肺腺癌伴两肺及胸膜转移1例,胃非霍奇金淋巴瘤1例,回盲部腺癌1例,盆腔高分化脂肪肉瘤1例,卵巢恶性畸胎瘤术后腹膜多发转移1例。结论 对产前超声检查疑诊为PAM的患者,可进一步行CT或MRI检查明确诊断,其中MRI检查可对各系统病变的性质进行诊断,以及更全面的评估,是合适的影像补充诊断方法。

Objective To investigate the clinical features and imaging diagnostic value of pregnancy associated malignancy(PAM).Methods Clinical data of 10 PAM patients,who were screened out from the picture archiving and communication system(PACS)from January 2010 to December 2020 by key words“tumors in pregnancy”and were pathologically confirmed by surgery or biopsy,were retrospectively analyzed.The mean age of the pregnant women was(32.7±4.6)years and gestational age at the time of treatment was 29 weeks.CT or MRI was performed in 5 patients with the abnormalities detected by prenatal ultrasonography(US)and in another 5 patients with clinical symptoms.General information of the patients(age,gestational week,treatment time after diagnosis,mode of delivery,fetal outcome,etc.),clinical presentation,prenatal US diagnosis,as well as results of mammography(MG),CT,and MRI were collected.The imaging data were analyzed and diagnosed by two experienced radiologists.Results After diagnosis of PAM,2 patients underwent induced labor,pregnancy was terminated with cesarean section in 4 patients,and pregnancy was continued in another 4 patients(including cesarean section at 37-37+6 weeks of gestation in 3 patients and termination of pregnancy due to intrauterine distress in 1 patient).MG,CT and MRI were performed in 2,2 and 7 patients,respectively.One patient with right lung cancer underwent chest CT scan after chest abnormalities were detected from abdominal MRI coronal plane.Breast cancer was confirmed by prenatal MG in 2 patients.Abdominal MRI images showed a mass in the lower lobe of the right lung and multiple small nodules in both lungs of one patient,and right lung cancer with diffuse metastatic nodules was diagnosed after further CT scan.CT scan showed marked heterogeneous gastric wall thickening in one patient.The results of prenatal MRI were malignant tumor from the stomach and right middle and lower abdomen,possible cystadenocarcinoma in right pelvic adnexa,malignant tumor of right pelvic adnexa,malignant tumor of ascending colon,possible pelvic liposarcoma and small abdominal metastatic nodules in 6 patients,respectively.Pathological results showed 3 cases of ovarian malignancies(1 case of gastric signet ring cell carcinoma with right ovarian metastasis,ovarian mucinous adenocarcinoma,and right ovarian immature teratoma,respectively),2 cases of breast infiltrating carcinoma,one case of right lung adenocarcinoma with lung and pleura metastases,one case of gastric non-Hodgkin’s lymphoma,one case of ileocecal adenocarcinoma,one case of pelvic well-differentiated liposarcoma,and one case of peritoneum metastases of postoperative malignant teratoma.Conclusion For prenatal suspected PAM,CT and MRI,especially MRI,can significantly improve the accuracy of lesions from all systems,and has a more comprehensive evaluation as the most appropriate supplemental imaging modality.