宫颈胃型腺癌的影像学分析(附8例报道)

Imaging analysis of gastric-type endocervical adenocarcinoma(with report of 8 cases)

目的:探讨宫颈胃型腺癌临床与影像学特点,以期提高认识与早期诊断水平。方法:搜集、分析2018年10月-2023年5月经病理证实的8例宫颈胃型腺癌的临床与影像学资料,其中4例术前接受MRI检查,6例接受妇科B超检查,2例接受CT检查,6例行阴道镜检查及活检。结果:①临床特点:阴道流液3例,其中大量流液1例,阴道出血2例,常规妇科超声体检发现宫颈可疑病变3例。宫颈液基细胞学检查(TCT)阴性5例(5/8),人乳头瘤病毒(HPV)检查阴性7例(7/8),6例行阴道镜及宫颈常规活检检查,阴性各4例(4/6、4/6)例。②影像学表现:MRI检查4例,均表现为子宫颈体积增大呈“桶状宫颈”,其内信号不均,以稍长T 1稍长T 2信号为主,内见多发大小不等类圆形长T 1、长T 2信号影,呈“宇宙征”,其中仅1例患者MRI结果考虑宫颈胃型腺癌(1/4)。CT检查2例,表现为子宫颈增大呈“桶状宫颈”,密度不均,散在多发结节及小片状低密度影,1例增强检查示病变囊性区未见无强化,实性部分呈不均匀强化,边界欠清。超声检查6例,表现为宫颈增大,见回声不均质团块,呈蜂窝状,团块内及周边见较丰富血流信号。术前影像学仅1例MRI检查考虑G-EAC(1/8),误诊/漏诊率87.5%。结论:宫颈胃型腺癌具有一定的临床特点与影像特征,临床表现为阴道持续大量流清水样液伴“桶状宫颈”、“宇宙征”的影像表现有助于宫颈胃型腺癌的早期诊断,MRI诊断价值明显。

Objective:To investigate the clinical and imaging characteristics of Gastric-type Endocervical Adenocarcinoma(G-EAC)with a view to increasing the level of awareness and early diagnosis.Methods:In this study,we retrospectively and consecutively collected and analyzed clinical and imaging data from eight patients with pathologically confirmed G-EAC.The data was collected at our hospital between October 2018 to May 2023.Out of the eight patients,four received preoperative MRI,six received gynecological ultrasound,and two underwent CT examinations.Additionally,six patients underwent colposcopy and cervical routine biopsy.Results:①Clinical characteristics:among the 8 cases analyzed,3 presented with vaginal discharge,including 1 case of profuse discharge,2 cases with vaginal bleeding,and 3 cases with suspected cervical lesions identified through routine gynecological ultrasound.Cervical liquid-based cytology(TCT)was negative in 5 cases(5/8),while human papillomavirus(HPV)testing was negative in 7 cases(7/8).Six patients underwent colposcopy and cervical routine biopsy,of whom 4 cases(4/6,4/6)were negative.②Imaging manifestations:in the 4 cases that underwent MRI,all presented with an enlarged cervix in the shape of a"barrel,"uneven parenchymal signal with slightly longer T 1 and T 2 signals,and multiple rounded long T 1 and long T 2 signal shadows of varying sizes visible in the cervix presenting the"cosmic sign."Only one patient had cervical gastric adenocarcinoma that was considered for a correct MRI diagnosis(1/4).In 2 cases,CT examination showed an enlarged cervix with"barrel-shaped cervix,"uneven density,scattered multiple nodules,and small flaky low-density shadows.In one case,enhancement examination revealed a cystic area with no enhancement,and the solid part had uneven enhancement with a poorly defined border.Ultrasound examination in 6 cases revealed an enlarged cervix with heterogeneous echoic masses,honeycomb-like appearance,and rich blood flow signals inside and around the masses.Only 1 case(1/8)was correctly diagnosed as G-EAC by preoperative imaging,leading to a misdiagnosis/missing diagnosis rate of 87.5%.Conclusion:Cervicogastric adenocarcinoma presents with specific clinical features and imaging characteristics.The persistent presence of a large amount of vaginal fluid with a"barrel-shaped cervix"and presenting the"cosmic sign"can aid in early diagnosis.MRI also holds diagnostic value in identifying the condition.