前列腺肉瘤的临床表现与MRI诊断

目的:探讨前列腺肉瘤的临床表现及MRI影像特征,提高诊断水平。方法:3例前列腺肉瘤,年龄23-45岁,中位数年龄25岁,3例均做快速自旋回波序列T1WI和T2WI轴位、矢状位和冠状位平扫,2例做增强扫描。结果:腺泡性横纹肌肉瘤2例,间质来源无法分类肉瘤1例。从始发症状到确诊约5-18月,临床症状为进行性排尿困难(2例),尿频(1例),下腹胀痛(2例),血尿(1例)。3例术前行血清酸性磷酸酶(PAP),碱性磷酸酶(AKP)及前列腺特异性抗原(PSA)检查均正常。2例2期均行手术及放化疗,1例3期未行手术,仅做化疗。术后随访2例生存8-15月,1例失访。MRI显示前列腺显著增大,呈榨菜分叶状占据盆腔的大部分,最大病灶为8.5 cm×8.3 cm×10.4 cm。T1WI信号不均,呈等或稍低信号,T2WI呈中高混杂信号,正常前列腺结构消失,中央带和外周带分界不清。1例精囊腺侵犯。增强扫描病灶明显强化,部分出现局灶性坏死区。结论:前列腺不规则显著增大及异常强化,中央带与外周带分界不清。病人年龄较轻,临床以排尿困难、下腹坠胀、尿频、血尿为主,血清PSA在正常范围,提示前列腺肉瘤。前列腺肉瘤恶性程度高,发展快,死亡率高。

Clinical and MRI Featlires of tlae Prostate Sarcoma

Objective: To study the clinical and MRI features of prostate sarcoma.Methods: Three cases of prostate sarcoma identified by pathology were enrolled in this study.Both the clinical and MRI data were review.Results: Among the three prostate sarcomas,two cases were glandular rhabdomyosarcoma,the other was sarcoma originated from interstitial tissue that could not be classified.The biggest focus in MRI was 8.5 cm×8.3 cm×10.4 cm.The serum PSA,PAP and AKP levels were normal before operation.The first symptom was dysuria accompanied swelling pain in the lower abdomen and haematuria.Final diagnosis was made after 5-18 months.Average survival year was no more than one year.The mass was huge in MRI,T1WI and T2WI signal were inhomogeneous and the normal prostate structure was destroyed.Conclusion: Dysuria and haematuria were main symptoms of the prostate sarcoma.Combined with the clinical appearance,MRI helps to diagnosis the prostate sarcoma.