睾丸间质细胞瘤的超声诊断

Ultrasound characteristics of testicular Leydig cell tumors

目的:总结超声诊断LCT的经验,提高临床水平超声诊断LCT的经验,提高临床水平。方法:回顾性分析我院收治睾丸间质细胞瘤患者4例,结合文献复习,归纳超声诊断睾丸间质细胞瘤的经验。结果:4例睾丸间质细胞瘤均为单发,左侧1例,右侧3例,均呈类圆形。肿物最小者:1.8 cm×1.5 cm,最大者:3.1 cm×2.5 cm,2例合并有睾丸鞘膜积液。2例肿物边界清晰,1例边界模糊,1例随访8个月后肿物边界由清晰转为模糊。4例肿物超声下为低回声,内部均可探测到血流,其中2例肿瘤内部血流丰富,1例肿物周边血流丰富,1例随访8个月后肿物周边环状血流转为内部丰富血流。结论:超声诊断LCT具有一定的规律:典型的散发性LCT,是一个孤立的低回声质量的肿块,与相邻的组织有明确的界限。它们表现出与典型的周边轮缘模式相关的内在高血管化。更大的病灶通常更易表现为分叶状和强烈的血管增生。LCT超声图像显示的特征虽不能确定病变的性质,但可以帮助外科医生决定是否选择行睾丸保留手术,或者对有生育需求的患者的可疑病灶进行主动监测,及时手术治疗。

Objective:To explore the color Doppler ultrasonic characteristics of testicular Leydig cell tumors(LCT)and improve the clinical diagnosis of the disease.Methods:We retrospectively analyzed 4 cases of testicular LCT diagnosed and treated in our hospital and summarized the experience in the ultrasonic diagnosis of LCT with a review of the relevant literature.Results:All the 4 testicular LCTs were solitary and quasi-round,1 in the left and 3 in the right.The smallest mass was 1.8×1.5 cm and the largest 3.1×2.5 cm,and 2 were complicated by hydrocele of tunica vaginalis.The margins of tumors were distinct in 2 cases and indistinct in 1,and changed from distinct to indistinct in another during the follow-up.Hypoechoes were revealed in all the 4 cases in ultrasonography,2 with abundant internal blood flow,1 with abundant peripheral blood flow,and the other with abundant internal blood flow changed from circular blood flow surrounding the mass.Conclusion:A typical sporadic LCT was ultrasonically manifested as an isolated hypoechoic infracentimetric mass with a clear demarcation from the adjacent pulp.It exhibited intrinsic hypervascularization associated with a typical peripheral rim pattern.Larger lesions more often presented a lobulated shape and intense hypervascularization.Although these ultrasonic characteristics do not reveal the nature of LCT with certainty,they can help the surgeon with the decision on testis-sparing surgery or perhaps even on the active monitoring for the smallest lesions in a population with impaired fertility.