高分化脂肪肉瘤及脂肪瘤的临床及超声特征分析

Clinical and ultrasonic features of well-differentiated liposarcoma and lipoma

目的观察并分析高分化脂肪肉瘤(WDL)与脂肪瘤的临床及超声特征。方法收集经手术病理证实的77例WDL及144例脂肪瘤的临床资料及超声声像图结果,比较两者的年龄、性别、位置、大小、边界、形态、回声及血流情况。结果 WDL组患者平均年龄大于脂肪瘤组(P<0.001),2组间性别差异无统计学意义(P=0.717)。WDL组最大径[(8.33±6.87)cm]大于脂肪瘤组最大径[(3.94±2.55)cm,P<0.001]。WDL组与脂肪瘤组肿瘤位置、回声、边界、形态及血流情况差异均有统计学意义(P均<0.05)。WDL组更常见于腹膜后(50/77,64.94%)及肌层(17/77,22.08%),脂肪瘤更常见于皮下(116/144,80.56%);WDL组高回声更多见(49/77,63.64%),脂肪瘤组以等回声居多(110/144,76.39%);WDL组边界不清楚42例(42/77,54.55%),脂肪瘤组边界清楚135例(135/144,93.75%);WDL组形态不规则49例(49/77,63.64%),脂肪瘤组形态规则133例(133/144,92.36%);WDL组血流分级0级30例(30/77,38.96%),1级23例(23/77,29.87%),2～3级24例(24/77,31.17%),脂肪瘤组0级110例(110/144,76.39%),1级34例(34/144,23.61%),无2～3级。结论高分化脂肪肉瘤较脂肪瘤平均年龄及体积均较大,好发于腹膜后及肌层,以高回声为主,边界不清楚,形态不规则,血供相对丰富。掌握以上特点有助于提高对两者的鉴别诊断水平。

Objective To observe and analyze the clinical and ultrasonic features of well-differentiated liposarcoma(WDL)and lipoma.Methods The clinic information and ultrasonic images of histopathologically proved 77 patients with WDL(WDL group)and 144 patients with lipoma(lipoma group)were collected.The differences of patients age,sex,tumor size,location,boundary,morphology,echogenicity and blood flow grade were analyzed between WDL and lipoma.Results The average age in WDL group was older than that in lipoma group(P<0.001).There was no significant difference in patients sex(P=0.717).The average size of WDL group([8.33±6.87]cm)was larger than lipoma group([3.94±2.55]cm,P<0.001).There were significant differences in location,echogenicity,boundary,morphology and blood flow grade between WDL group and lipoma group(all P<0.05).The WDLs were often located in retroperitoneum(50/77,64.94%)and muscular layer(17/77,22.08%),while lipomas were often located in subcutaneous layer(116/144,80.56%).WDLs were often hyperechogenic(49/77,63.64%)while lipomas were often isoechoic(110/144,76.39%).Forty-two WDLs(42/77,54.55%)had unclear boundary,135 lipomas(135/144,93.75%)had clear boundary.Forty-nine WDLs(49/77,63.64%)had irregular morphology,133 lipomas(133/144,92.36%)had regular morphology.The blood flow grades of 30 WDLs(30/77,38.96%)were grade 0,23 WDLs(23/144,29.87%)were Grade 1,24 WDLs(24/77,31.17%)were grade 2—3;110 lipomas(110/144,76.39%)were grade 0,34 lipomas(34/144,23.61%)were grade 1 and no lipoma was grade 2—3.Conclusion WDL has a greater average age and a larger average size than lipoma.It is often located in retroperitoneum and muscular layer and is mainly hyperechogenic,more unclear and irregular with relatively higher vascularity.Learning these manifestations will improve the differential diagnosis of these two lesions.