腹部促纤维结缔组织增生性小圆细胞瘤CT表现及病理对照

目的：探讨腹部促结缔组织增生性小圆细胞肿瘤（DSRCT）的CT表现。方法：回顾性分析经病理证实的8例DSRCT患者的CT表现,8例患者均行CT增强扫描,并对其CT表现与病理学进行对照分析。结果：3例DSRCT单发,5例多发;病变主要位于膀胱后方（n=5）及肠系膜间隙（n=5）;CT表现为腹、盆腔内分叶状或结节状低密度肿块;可见坏死区（n=3）及钙化灶（n=4）;增强扫描均表现为不均匀强化,平扫、增强扫描动脉期及静脉期肿块的平均CT值各为38.9 HU5、6.1 HU6、2.5 HU。8例肿瘤病理特点均表现为瘤组织呈片状或巢状弥漫浸润性生长,中间由宽厚的纤维结缔组织分隔,3例可见瘤内坏死。结论：DSRCT的CT表现与病理之间存在一定的相关性,CT有助于DSRCT的诊断、分期及定位活检。     

Radiologic findings of gastrointestinal tract involvement in hepatocellular carcinoma.

PURPOSE: The purpose of this work was to evaluate the radiologic findings of gastrointestinal (GI) tract involvement in hepatocellular carcinoma (HCC) and to discuss mechanisms of spread. METHOD: Eighteen patients with histologically proven GI tract metastasis in HCC for 4.5 years underwent CT and five also underwent upper GI (UGI) series. The cases were classified according to the mode of spread, based on the radiologic findings. RESULTS: The involved portion of the GI tract was the stomach (n = 11), duodenum (n = 4), and colon (n = 4). The mode of spread was direct invasion from a contiguous primary tumor (n = 12), hematogenous metastasis (n = 3), peritoneal seeding (n = 1), and undetermined (n = 2). In cases of direct invasion from contiguous primary tumors, CT revealed GI tract invasion directly from bulky hepatic masses (n = 9) or daughter masses at the portion of the bowel wall contiguous to the hepatic masses (n = 3). In cases of hematogenous spread, CT revealed an intramural mass in the stomach and duodenum (n = 2) or a diffuse thickening of the wall of the stomach (n = 1). In the case of peritoneal seeding, CT revealed multiple small nodules in the right paracolic gutter, omentum, and mesentery with invasion to the colon. CONCLUSION: GI tract involvement in HCC shows various radiologic findings according to the mode of spread, but the most common finding is direct invasion of the stomach, duodenum, or colon from contiguous primary tumor.     

胃肠道外间质瘤的CT诊断价值

目的分析胃肠道外间质瘤(EGIST)的CT表现特征,探讨CT对该肿瘤的诊断价值。资料与方法回顾性分析25例经手术或穿刺病理证实EGIST患者的CT表现(病变的部位、大小、形态及边缘、增强特点、邻近脏器受侵、转移等征象),25例均行CT平扫及双期增强扫描,其中8例又行CTA检查。结果 25例EGIST中,高度危险17例,中度危险5例,低度危险3例,其中5例发生远处转移。单发23例,位于肠系膜10例、网膜6例、后腹膜5例、盆腔2例;多发2例,起自后腹膜及肠系膜。肿瘤直径平均13.2 cm。肿块呈分叶状8例,不规则状4例,类圆形或椭圆形13例。其中1例可见钙化,23例病灶内见囊变及坏死。根据肿瘤的强化方式,分两种类型:Ⅰ型,动脉期大致轻度均匀强化,静脉期强化略高于动脉期。Ⅱ型,动脉期为中度不均匀强化,静脉期进行性强化,强化高于动脉期;囊变、坏死无明显强化;其中15例在动脉期病灶实性成分内可见条状强化的血管影;CTA可清晰显示肿瘤供血动脉及引流静脉。结论 EGIST的CT表现有一定的特征性,在术前诊断及术后随访判断其生物学行为方面有一定价值。     

Desmoplastic small round cell tumor of the abdomen: radiologic-histopathologic correlation

PURPOSE: To characterize the imaging features of desmoplastic small round cell tumor of the abdomen and correlate them with the histopathologic findings. MATERIALS AND METHODS: Eleven of 14 patients with desmoplastic small round cell tumor had primary abdominal involvement. In nine of these patients (mean age, 20 years), results of imaging studies (computed tomography in nine patients, ultrasonography [US] in three) and histopathologic specimens were retrospectively analyzed. RESULTS: The hallmark imaging feature was lobulated peritoneal masses (mean number, 4.4; range, 1-17) with a mean diameter of 5.0 cm (range, 2-12 cm). Omental and paravesical tumors were each present in six patients. Retroperitoneal masses were present in three patients. The tumors were well defined and hypoechoic at US. Heterogeneity due to tumor hemorrhage or necrosis was seen in seven patients. Ascites was present in five patients. Parenchymal and/or serosal hepatic metastases, punctate calcifications, nodular peritoneal thickening, lymphadenopathy, hydronephrosis, and bowel obstruction were less common associated findings. CONCLUSION: Bulky peritoneal soft-tissue masses without an apparent organ-based primary site are characteristic of intraabdominal desmoplastic small round cell tumor. Although the findings are nonspecific, this diagnosis can be considered in adolescents and young adults with characteristic imaging findings.     

盆部原发肿瘤CT表现特征及其解剖学基础

目的分析盆部原发肿瘤CT增强表现特征，探讨产生各种影像表现的病理学和解剖学基础。方法回顾性分析14例经病理学证实的盆部原发肿瘤CT增强表现，包括病灶大小、密度、边缘、强化特征，肿块所在的解剖部位及其与邻近组织器官和间隙的关系等。结果良性肿瘤3例，恶性肿瘤11例。肿块位于盆腹膜腔和腹膜外间隙各6例，盆腹膜腔和腹膜外间隙同时受累2例。CT增强表现为实质性8例，囊实性6例；均匀强化3例，不均匀强化11例。肿块周围脂肪间隙清晰和受侵犯各7例。4例病灶内出现钙化，其中良性畸胎瘤2例，恶性畸胎瘤和类癌各1例。结论CT增强扫描能准确判断盆部原发肿瘤的解剖位置及其与邻近解剖结构的毗邻关系，初步判断肿瘤的良恶性，对畸胎瘤能做出比较明确的定性诊断。     

肠系膜肿块的CT诊断

目的 分析肠系膜肿块的CT表现,探讨CT对其定位,定性及鉴别诊断的价值和限度,资料与方法 对经手术,病理,活检等证实的18例肠系膜肿块的CT表现,结合其手术病理及部分超声所见进行回顾分析。选用窗宽300-400HU,窗位0HU观察病灶及其邻近肠系膜。结果 18例肠系膜肿块中,16例发生在小肠系膜（回肠15例,空肠1例）,升,横结肠各1例,其中恶性淋巴瘤6例（非霍奇金病5例,霍奇金病1例）,淋巴管瘤,炎性假瘤各3例,转移瘤2例,血管外皮细胞肉瘤,平滑肌肉瘤,纤维瘤,单纯囊肿各1例,除2例淋巴瘤和1例转移瘤呈多个肠系膜肿块,部分病例伴有腹膜后肿块,其余病例均呈孤立性肿块（此为唯一的CT表现）。肿块推压肠管,部分被肠系膜肿块,部分病例伴有腹膜后肿块,其余病例均呈孤立性肿块（此为唯一的CT表现）,肿块推压肠管,部分被肠管包绕,邻近肠系膜模糊,“三明治”征多见于恶性淋巴瘤。结论 CT对肠系膜肿块有较大的诊断价值。结合病变的解剖,病理基础以及超声特征等,术前多可做出提示性甚至正确的定位,定性诊断,对少数难以确诊的病例,应行CT导引下穿刺活检确诊。     

肠系膜罕见原发肿瘤的CT表现(4例报告及文献复习)

目的: 描述肠系膜罕见原发肿瘤的CT 特点。材料与方法: 搜集4 例,其中恶性血管外皮细胞瘤( MHP) 和恶性纤维组织细胞瘤( MFH) 各1 例,神经纤维瘤( NF)2 例,均经手术和病理证实。与手术对照分析这些肿瘤的CT 表现特点。结果: MHP 原发肿瘤不具特征性,肝转移病灶可表现为多发的形态规则、界线清楚的圆形病灶,部分病灶内可见液面,可有双环征。MFH 仅表现为一不规则形软组织肿块。2 例NF 均表现为无痛性的、体积较大的且有明显的偏侧囊变的混合密度性肿块。结论: MHP 肝转移和NF 可能具有一定的CT 表现特征,但仍需获得组织学证实     

CT in primary malignant germ cell tumors of the retroperitoneum.

Malignant germ cell tumors may exist as a primary entity in the retroperitoneum. In a CT study of 14 males with this condition (2 seminomas and 12 non-seminomatous tumors) all masses were large, lobulated and of mixed density. Fat plane obliteration against adjacent structures was frequent. The aorta was embedded in 9 patients and the inferior vena cava was affected in 7, 2 of whom had signs of compromised caval blood flow. Distant metastases were found in the lungs (7 patients), liver (n=4), posterior mediastinum (n=3), and in brain and supraclavicular lymph nodes in one patient each. Serum biomarkers were elevated in 11 patients. An extragonadal germ cell tumor should be considered when CT of the abdomen reveals a large retroperitoneal mass with mixed density.     

胃肠道间质瘤的螺旋CT诊断

目的:探讨胃肠道间质瘤(GIST)的螺旋CT表现及诊断价值.方法:回顾性分析经手术和病理证实的胃肠道间质瘤患者18例,术前均行螺旋CT扫描,7例行双期增强扫描.结果:肿瘤位于胃部8例,食管1例,十二指肠2例,小肠4例,回肠末端小肠系膜、横结肠系膜各1例,未确定原发部位者1例.无论良、恶性,CT表现17例边界清楚;瘤体内多发坏死、囊变10例,无囊变者密度均匀,为软组织密度;肿瘤边缘分叶12例;病变腔内侧面溃疡7例,气体及对比剂进入其中;钙化1例,转移2例,未见淋巴结转移;增强扫描,肿瘤中度到明显强化;螺旋CT定位准确度为77.8%,判定良、恶性准确度为50%.结论:螺旋CT对于胃肠道间质瘤的定位和提示诊断都具有非常高的价值,对肿瘤良恶性的判断有一定限度,确诊有赖于病理学检查.     

盆腔器官外软组织肿瘤的CT诊断

目的 探讨盆腔器官外软组织肿瘤的CT表现及其诊断价值。材料与方法 回顾性分析经手术病理证实的30例原发性盆腔器官外软组织良、恶性肿瘤的CT表现。其中间叶源性肿瘤15例,神经源性肿瘤8例,胚胎残余组织源性肿瘤5例,腹膜间皮细胞肿瘤2例。结果 原发于盆腔器官外软组织肿瘤较少见,CT表现为囊性肿块者均为良性,囊实性或实性者以恶性居多。虽然肿瘤来源于多种不同组织,但CT表现可各有其特征。结论 CT是诊断盆腔器官外肺瘤的重要影像学手段,能明确肿瘤范围以及肿瘤与周围组织的关系及其性质。     

Computed tomography of renal lymphoma

The CT studies of 29 patients with renal or perirenal lymphoma were retrospectively reviewed. Four patterns of disease were identified. Seventeen of 29 patients (59%) had bilateral renal masses. Only seven of these patients had associated enlarged retroperitoneal lymph nodes. Eight patients (28%) had single renal or perirenal lesions adjacent to or contiguous with bulky retroperitoneal lymphadenopathy. Three patients had infiltration of the perirenal space without significant renal parenchymal involvement, and one patient had a solitary renal mass. No patients in this series had diffuse involvement of the kidney without a focal mass. Renal involvement with lymphoma should be considered in any patient who develops multiple homogeneous solid renal or perirenal masses, even in the absence of other retroperitoneal disease.     

Desmoplastic small round cell tumor in the abdomen and pelvis: report of CT findings in 11 affected children and young adults

OBJECTIVE: Our objective was to evaluate the CT features of desmoplastic small round cell tumor (DSRCT) of the abdomen and pelvis in pediatric and young adult patients. CONCLUSION: Characteristic CT features of DSRCT include bulky intraabdominal soft-tissue masses that involve omental and serosal surfaces, without a distinct organ of origin; solid, dominant, heterogeneous pelvic masses in the retrovesical or rectouterine spaces; and concurrent metastases, common at the time of diagnosis, particularly those involving lymph nodes and liver.     

外周原始神经外胚叶肿瘤的临床及CT、MRI诊断

目的分析外周原始神经外胚叶肿瘤(pPNET)的临床特点和CT、MRI表现,以提高对该病的认识。资料与方法回顾分析8例经病理证实的pPNET的临床表现和CT、MRI征象。结果原发于上肢pPNET1例,头面部2例,腹膜后2例,脊柱旁3例。初诊时2例有骨转移,1例颌下淋巴结肿大。病灶体积较大,呈浸润生长,推压邻近结构,并可凸入椎管。肿瘤密度／信号不均,CT为软组织密度,轻至中度强化;MR T1WI肿块与肌肉等信号,T2WI呈不均匀高信号,增强扫描呈花环状或蜂窝状强化。1例有钙化,3例邻近骨质破坏,呈溶骨性破坏伴骨膜反应。结论pPNET是好发于青少年的少见恶性小圆形细胞肿瘤,预后差。CT、MRI征象无特异性,但对评价肿瘤的可切除性、治疗效果和制订治疗方案非常有价值。     

Computed tomography of abdominal carcinoid tumor

Computed tomography of the abdomen was performed in 10 patients with pathologically proven carcinoid tumor. In four patients numerous tiny punctate and radiating densities were seen in the mesentery. Two of these patients also had rounded mesenteric masses, 2.5-5 cm in diameter. The presence of punctate or radiating mesenteric densities reflecting desmoplastic reaction, when combined with rounded mesenteric masses or liver metastases, is highly suggestive of carcinoid tumor. The CT appearance of the hepatic metastases in this group of patients was also assessed and found to be nonspecific.     

Intra-abdominal desmoplastic small round-cell tumor: a rare cause of peritoneal malignancy in young people

We report the CT and pathological findings of an intra-abdominal desmoplastic small round-cell tumor in a young man. Computed tomography showed an extensive peritoneal and mesenteric disease with gross bulky masses, direct liver invasion, and lymph node involvement. This entity should be considered in the differential diagnosis of a young male patient presenting with features of widespread peritoneal malignant disease. Received: 18 February 1999; Revised: 8 June 1999; Accepted: 13 September 1999     

隐睾合并精原细胞瘤的CT征象分析

目的:探讨隐睾合并精原细胞瘤的CT特点,以期提高对本病的认识.方法:对7例经手术病理证实的隐睾合并精原细胞瘤的CT图像进行回顾性分析.结果:7例隐睾合并精原细胞瘤中,2例位于后腹膜,3例位于盆腔腹膜外,2例位于腹股沟管.其CT征象有肿块以实质性为主;肿块可有完整包膜,如边缘不清则提示有局部侵犯;肿块长轴多与睾丸下行路径一致;腹股沟管内口附近肿块可见伪足状突起.结论:隐睾合并精原细胞瘤的CT征象有相对特征性,对于本病的诊断具有重要价值.     

CT findings of regression in intraabdominal desmoplastic small-cell tumor

We report the computed tomographic (CT) findings in a patient with intraabdominal desmoplastic small-cell tumor before and after 10 weeks of chemotherapy. This tumor is a rare, frequently fatal neoplasm of the peritoneum, seen predominantly in young males. Initial CT demonstrated large intraperitoneal masses, hepatic metastases, retroperitoneal and right axillary lymphadenopathy, ascites, and pleural effusion. Follow-up CT showed marked decrease of the main tumor bulk and complete regression in the axillary nodes.     

多层螺旋CT诊断恶性胃肠道间质瘤

目的：探讨多层螺旋CT（MSCT）诊断恶性胃肠道间质瘤（GIST）。方法：回顾性分析经手术及病理症实的27例恶性GIST的多层螺旋CT表现。全部病例均作平扫及增强双期扫描,并作多平面重建后处理。结果：肿瘤来源于胃11例,小肠9例,结肠5例,肠系膜2例;肿瘤横径4．2～22cm。边缘清晰12例,边缘不清15例。肿瘤形态多不规则,19例可见分叶。平扫病灶密度不均匀,增强扫描动脉期呈中度至明显强化,静脉期呈持续性强化。病灶内部可见多数大小不等的坏死区,9例呈囊实质性改变。合并肝脏转移4例,肺部转移1例,淋巴转移2例。本组定位准确率为85．2％（23／27）,定性准确率77．8％（21／27）。结论：多层螺旋CT增强双期扫描、轴面结合多平面重建图像对恶性GIST的诊断有重要价值。     

胃肠道外间质瘤的临床病理特点和CT表现

目的:探讨胃肠道外间质瘤(EGIST)的临床病理特点和CT表现。方法:12例经手术病理证实的胃肠外间质瘤的患者均经CT平扫加增强扫描,回顾性分析其临床病理特点及影像学表现。结果:12例EGIST,腹膜后间隙4例,肠系腹5例,网膜3例。瘤体最大直径6~14cm,平均8cm。10例肿瘤呈圆形或卵圆形,2例呈分叶状。9例边界清晰,3例边界不清。8例肿瘤可见囊变坏死,4例肿瘤内见出血。增强后12例呈明显不均性强化。6例伴有肝脏转移,3例伴有腹膜转移,未见腹水和转移性淋巴结肿大征象。组织病理检查,梭形细胞型8例,上皮样细胞型3例,混合型1例。免疫组化检查,所有病例CD117均表达阳性,7例CD34表达阳性。结论:临床上,EGIST很少出现消化道出血和梗阻症状,其病理特点与GIST相似,CT表现除肿瘤形态多呈圆形或卵圆形外,肿瘤大小、边缘、增强模式、转移和播散方式均类似于恶性GIST。     

Metastatic myxoid liposarcomas: imaging and histopathologic findings

Objective The objective was to describe the imaging and histopathologic characteristics of metastatic myxoid liposarcomas. Materials and methods This retrospective study was approved by the institutional review board and complied with HIPAA guidelines. The study group comprised 12 patients with metastatic myxoid liposarcoma who underwent MRI, CT, or FDG-PET. The location and imaging characteristics of the metastatic lesions were recorded, and the histopathology of all metastatic lesions was reviewed. Results There were 23 histologically proven metastases in 12 patients. Based on imaging criteria, there were 41 metastases. The mean time from the diagnosis of primary tumor to the first metastasis was 4.4 years. Sixty-seven percent of patients had bone and soft tissue metastases, 33% had pulmonary metastases, 33% had liver metastases, 25% had intra-abdominal, and 16% retroperitoneal metastases. CT demonstrated well-defined lobulated masses with soft tissue attenuation in all cases, without macroscopic fat component. In cases of osseous metastases, CT showed mixed lytic and sclerotic foci, with bone destruction in advanced cases. MRI demonstrated fluid-like signal intensity with mild heterogeneous enhancement in cases of soft tissue metastases. In osseous metastases, MRI showed avid heterogeneous enhancement. FDG-PET showed no significant FDG uptake for all metastases. MRI was the most useful imaging modality for osseous and soft tissue metastases. Conclusion Myxoid liposarcomas are soft tissue sarcomas, with a high prevalence of extrapulmonary metastases. The bones and soft tissues were the most common site of involvement, followed by the lungs and liver. MRI was the most sensitive modality in the detection of osseous and soft tissue metastases, and is the recommended modality for the diagnosis and follow-up of bone and soft tissue involvement.