睾丸卵黄囊瘤、畸胎瘤、精原细胞瘤的超声诊断标准再探讨及应用价值

目的 探讨睾丸卵黄囊瘤、畸胎瘤及精原细胞瘤的超声诊断标准并评估其应用价值.方法 回顾性分析经病理确诊的30例睾丸肿瘤的声像图特征.如实记录各种睾丸肿瘤的术前超声诊断结果,评估术前高频超声定性诊断睾丸卵黄囊瘤、畸胎瘤及精原细胞瘤的能力.总结它们的临床和超声特征、拟定新的诊断标准并将之用作诊断性试验.结果 睾丸卵黄囊瘤主要见于小儿,血清甲胎蛋白阳性,超声表现为睾丸内混合性包块,内部可见多个不规则小片状液性暗区.畸胎瘤多见于小儿,甲胎蛋白阴性,超声表现内部回声混杂不均,粗大钙化和囊性区多见.精原细胞瘤见于成人,甲胎蛋白阴性,超声上以肿瘤内散在条索状高回声为其特征表现.术前及采用拟定的诊断标准后诊断准确性分别为:卵黄囊瘤,46.7%(14/30) vs 90.0%(27/30)(P＜0.001);畸胎瘤,63.3%(19/30) vs 96.7%(29/30)(P=0.001);精原细胞瘤,40.0%(12/30) vs 80.0%(24/30) (P=0.001).结论 睾丸卵黄囊瘤、畸胎瘤、精原细胞瘤的超声表现具有特征性.总结的临床和超声特征能明显提高高频超声定性诊断这3种睾丸肿瘤的能力,拟定的诊断标准值得应用推广.     

超声对儿童睾丸肿瘤的诊断价值

目的总结儿童睾丸肿瘤的超声表现,探讨超声对儿童睾丸肿瘤的诊断价值。方法对我院2005年1月至2009年12月经手术或睾丸穿刺活检后病理证实的72例儿童睾丸肿瘤病例的彩色多普勒超声及二维超声图像进行回顾性分析。结果卵黄囊瘤(19例)超声声像图表现为中等或低回声的实性包块,可见不规则低回声或小囊区。畸胎瘤(25例,其中隐睾发生3例)超声声像图为囊性、实性和(或)钙化按不同比例组成的混合回声包块。表皮样囊肿(6例)超声声像图呈中等或稍强不均匀回声包块,偶见包膜环状钙化。皮样囊肿(6例)超声声像图显示为囊性和(或)实性不均质包块。睾丸白血病浸润(9例)和睾丸淋巴瘤(5例)超声声像图均呈结节、团块或弥漫性分布的睾丸内低回声灶。睾丸转移瘤2例。结论儿童睾丸肿瘤中生殖细胞瘤发病率最高。儿童睾丸肿瘤的超声表现特点突出,超声是其首选的检查方法。     

阴囊内腺瘤样瘤超声表现及误诊分析

目的 观察原发性卵黄囊瘤患者的CT表现。方法 回顾性分析经病理证实的31例原发性卵黄囊瘤的临床及CT表现,其中8例仅接受CT平扫,23例接受CT平扫及增强扫描。结果 19例肿瘤位于性腺,包括单侧卵巢11例,睾丸8例;12例肿瘤位于性腺外,包括骶尾部7例,前纵隔3例,阴道2例。20例肿瘤呈椭圆形,11例形态不规则;20例肿瘤边界相对清楚,11例边界模糊;2例合并畸胎瘤,瘤内可见脂肪、钙化。增强扫描示23例肿块实性部分呈中度至明显强化,17例呈丝瓜瓤样强化,18例可见供血血管,21例病灶边缘见延迟强化的包膜;4例显示肿瘤包膜破裂。结论 卵黄囊瘤CT表现具有一定特征性,可为诊断提供影像学依据。     

高频超声对睾丸卵黄囊瘤的诊断价值

目的探讨高频超声对睾丸卵黄囊瘤的诊断价值。方法 2005年3月-2011年5月11例经手术及病理检查证实为睾丸卵黄囊瘤患者,将其超声影像资料进行回顾性分析。结果 11例睾丸卵黄囊瘤声像图表现为:边界清楚9例;形态规则8例;混合回声5例,低回声3例,等回声3例;内部血流信号丰富8例;伴钙化2例,液化5例。结论睾丸卵黄囊瘤的高频超声表现有一定的声像特征,结合临床症状、血清学检查,对其有重要的诊断价值,是诊断睾丸卵黄囊瘤的首选方法。     

睾丸恶性肿瘤的超声表现

目的 探讨睾丸恶性肿瘤的超声表现。方法 回顾性分析32例经病理证实的睾丸恶性肿瘤患者声像图特征,包括肿瘤的大小、形态、边界、内部回声、血流情况以及邻近组织有无侵犯、淋巴结有无转移等。结果 32例睾丸恶性肿瘤患者中,生殖细胞瘤25例,其中精原细胞瘤15例;26例呈局限性肿块,20例回声不均,13例可见液性暗区,11例可见钙化;27例血供显示为Ⅱ级或Ⅲ级,4例邻近组织受侵,14例发现淋巴结转移。超声检出率为100%(32/32),诊断敏感度为90.62%(29/32)。结论 超声检查对睾丸恶性肿瘤有很高的诊断价值,如结合患者的年龄、病史等其他临床资料,还可以提高部分肿瘤分型诊断的准确性,如卵黄囊瘤、淋巴瘤、精原细胞瘤。     

婴儿肝血管内皮瘤的超声诊断价值

目的 探讨婴儿肝血管内皮瘤(IHHE)的声像图特点.方法 回顾性分析14例IHHE的超声和临床资料,并与CT、MR进行对照研究.结果 14例中肿瘤单发6例,多发5例,弥漫性3例.单发或多发肿瘤超声显示边界清楚,内部回声不均匀,4例瘤内可见钙化灶,6例可见无回声区;弥漫性者瘤体边界不清而难以辨认,全肝回声极度紊乱;4例肝动脉和腹腔干开口以上腹主动脉扩张,而腹腔干开口以下的腹主动脉相对变细.彩色多普勒示瘤内血供丰富,8例可见血管扩张,4例可检出动静脉瘘.结论 IHHE的超声表现具有一定的特征性.     

左乳导管内癌并右乳腺癌肉瘤超声表现1例

患者女,55岁,左侧乳晕外侧肿物4个月,左乳头黄色溢液1个月。体格检查,发现左乳头内陷,左乳晕旁可触及一肿物,约5cm×4cm大小,质硬,边界不清,活动欠佳,与皮肤表面粘连。超声检查：左侧乳房外侧象限内见一实质性低回声包块,边界不清,形态不规整,凹凸不平,无包膜,边界呈蟹足状,肿块内部可见点状强回声钙化灶,中心可见少许液化坏死的无回声区,后壁回声减低。于肿块内部可探及点条状血流信号,     

卵黄囊瘤声像图与病理对照分析

目的：探讨12例卵黄囊瘤二维声像图特征及其病理组织结构。方法：12例卵黄囊瘤经超声检查了解其形态，边界，内部回声及肿块后方回声，术后全部经病理组织学证实。结果：本组12例卵黄囊瘤以实性为主混合性包块多见（10/12），肿瘤内部以实质性等回声为主，形态不规则，边界清晰，可移动，其内乳头状强回声与液性暗区相互交错，后方回声衰减，结论：根据卵黄囊瘤声像图表现。参考AFP测值可明确诊断。     

睾丸扭转61小时手术复位后血供恢复1例

患者男，19岁。左侧阴囊疼痛两天余就诊。查体：左侧睾丸附睾体积增大，质地稍硬，压痛。外院及我院均临床拟诊为左侧睾丸附睾炎。LOGIQ-5及PHILIPS-IU22彩色多普勒超声诊断仪均显示：左侧睾丸呈斜位，形态尚正常。包膜光滑、完整，实质回声不均匀，周边及内部可见多个片状低、强回声区，边界不清。左侧附睾头大小尚正常，实质回声亦不均匀，其内也可见多个边界不清的低、强回声区。     

小儿睾丸肿瘤的超声诊断

目的 探讨小儿睾丸肿瘤的超声表现及超声在小儿睾丸肿瘤诊断中的应用价值。方法 对39例小儿睾丸肿瘤的二维及彩色多普勒超声图像进行回顾性分析，均经手术、病理证实。结果 在39例小儿睾丸肿瘤中，以生殖细胞肿瘤所占比例最高，占87．2％(34／39例)，其中卵黄囊瘤(占50％)的声像图多表现为实质不均质型，内可有少许液性成份，血供较丰富。良性畸胎瘤(占47．1％)大多表现为以囊性成份为主的团块，内有钙化灶。其余5／39例分别为白血病睾丸浸润(2例)、表皮样囊肿(2例)及睾丸间质细胞瘤(1例)。结论 超声诊断小儿睾丸肿瘤具有较高的临床应用价值及便捷、无创伤，是诊断小儿睾丸肿瘤的首选影像学检查方法。     

Leiomyoma of the testis: a rare testicular mass

We report the sonographic appearance of a testicular leiomyoma, which is a rare smooth muscle tumor of the testis. The patient presented with a painless testicular mass that was confirmed as an intratesticular tumor on sonographic examination. Histopathologic examination revealed a testicular leiomyoma.     

未成年人睾丸肾上腺残基瘤的超声表现

目的总结未成年人睾丸肾上腺残基瘤（TART）的超声表现。 方法回顾性分析中山大学附属第一医院经手术病理或临床确诊的13例未成年人TART的超声表现。分析内容包括受累睾丸数目及形态、大小、睾丸纵隔有无受累;病灶位置、生长方式、形态、边界、包膜、大小、内部回声、血供等指标。 结果13例TART均为双侧睾丸同时发病,共26个病灶,其中5例（5/13,39%）患者的睾丸大小及形态均正常,8例（8/13,62%）患者睾丸增大;12例（12/13,92%）患者睾丸内可见睾丸纵隔回声;26个（26/26,100%）TART均呈局限性生长,位于睾丸门或睾丸纵隔旁,21个（21/26,81%）病灶形状不规则,5个（5/26,19%）病灶呈类圆形;26个（26/26,100%）病灶均边界清楚,未见包膜回声;病变大小为（1.5±1.0）cm;13个（13/26,50%）病灶呈均匀低回声,11个（11/26,42%）病灶呈不均质低回声,2个（2/26,8%）病变呈不均质等回声;19个（19/26,73%）病灶血供丰富,7个（7/26,27%）病灶血供稀少。 结论未成年人TART双侧发病、低回声围绕睾丸纵隔生长的超声表现具有特征性,超声检查具有重要的临床意义。     

超声评价原发性睾丸淋巴瘤

目的探讨原发性睾丸淋巴瘤的超声诊断价值。方法回顾性分析经病理证实的9例原发性睾丸淋巴瘤患者(7例患者单侧睾丸肿大伴有胀痛,2例患者双侧睾丸肿大伴胀痛)的超声声像图表现。结果超声检查显示3例患者病灶位于左侧,4例患者病灶位于右侧,2例患者病灶位于双侧,肿瘤大小为2.8~5.5cm;病灶均呈低回声,弥漫分布,占据大部分睾丸实质,彩色多普勒检查在病灶内部探及丰富的血流信号;8例超声诊断为睾丸恶性肿瘤,但未能作出睾丸淋巴瘤的诊断,1例误诊为睾丸炎症;7例患者经手术确诊,2例患者经超声引导穿刺活检确诊。结论原发性睾丸淋巴瘤的临床及超声表现无特异性,临床诊断需综合分析,对疑似病例应行超声引导下穿刺活检明确诊断。     

儿童睾丸卵黄囊瘤的CT和MRI诊断

【目的】分析儿童睾丸卵黄囊瘤的临床特点和CT、MRI表现,以提高对该病的认识。【方法】回顾性分析15例经手术和病理证实的儿童睾丸卵黄囊瘤的临床表现和CT、MRl征象。12例行CT检查,3例行MRI检查。【结果】15例均表现为睾丸内软组织肿块,无钙化及脂肪成分,10例密度／信号不均匀,5例密度均匀。CT平扫肿瘤密度稍低于肌肉密度,增强扫描肿块表现为明显不均匀强化,以周边部强化明显。MRI平扫肿瘤T1WI呈不均匀或略低信号,T2WI呈不均匀高信号,增强扫描表现为明显不均匀强化。1例腹膜后淋巴结转移。【结论】CT及MRI检查在儿童睾丸卵黄囊瘤的诊断中有重要价值,了解其影像学特点,结合临床资料可以提高术前诊断和分期的准确性。     

Leydig cell tumors of the testis: gray scale and color Doppler sonographic appearance.

OBJECTIVE: To determine the gray scale and color Doppler sonographic features of Leydig cell tumors of the testis in a series of patients. METHODS: We retrospectively analyzed the sonographic appearance of 10 proven Leydig cell tumors in 9 patients aged 26 to 47 years. Sonographic features that were reviewed included the size and echogenicity of the tumors, presence of cystic areas or calcifications, and distribution pattern of detectable blood flow on color or power Doppler imaging. RESULTS: The tumors ranged from 0.4 to 3.0 cm in diameter, but most were less than 1.0 cm in diameter. In 1 testis, 2 discrete Leydig cell tumors were found. Nine (90%) of the 10 tumors were homogeneously hypoechoic. Only 1 tumor was isoechoic with the testis. None of the tumors contained calcifications. Of 8 tumors with color Doppler imaging, 7 (88%) showed a characteristic pattern of increased peripheral blood flow, which was either circumferential or punctate. Only 1 tumor was found with internal hypervascularity. CONCLUSIONS: Peripheral hypervascularity in a hypoechoic testicular tumor that has little or no internal color Doppler flow should suggest the possibility of a Leydig cell tumor, and consideration should be given to testicle-sparing surgery.     

睾丸表皮样囊肿的超声表现及分型

目的探讨睾丸表皮样囊肿的声像图表现,总结其声像图特征并分型。方法回顾分析经手术病理证实的21例睾丸表皮样囊肿的声像图特征并进行分型。结果 21例睾丸表皮样囊肿患者21个病灶声像图表现不一,大致可分为5型:(1)洋葱环征型(12例):呈同心圆状高回声与低回声相间分布的层状洋葱环样排列。(2)周边钙化型(蛋壳样钙化型)(3例):周边为薄层环状强回声,内部为均质或不均质的低回声。(3)类实性团块型(3例):呈边界清楚的低回声团块,内部回声均质。(4)混合回声型(2例):内部回声混杂,以低回声为主,可见钙化及小囊样回声。(5)整体钙化型(1例):整个结节呈现强回声,后方伴有明显声影。21例肿块内部均未探及血流信号。本组超声检查与病理结果相符者20例,诊断符合率为95.2%(20/21)。结论洋葱环征型及周边钙化型为睾丸表皮样囊肿的特征性超声表现,正确识别对指导临床治疗具有重要价值。     

Sonographic classification of testicular tumors by tissue harmonic imaging: experience of 58 cases

Purpose

To evaluate the relationship between our proposed sonographic classification of testicular tumors by tissue harmonic imaging and histological type.

Methods

We retrospectively analyzed 58 testicular tumors and tumor-like lesions [seminomatous germ cell tumor (SGCT): 28; non-seminomatous germ cell tumor (NSGCT): 16; lymphoid and hematopoietic tumor (LHT): 7; Leydig cell tumor: 1; epidermal cyst: 2; and tumor of paratesticular structure (TPS): 4]. We divided a sonographic image into six types for morphological criteria and three types for color Doppler criteria. We examined the relationship between the sonographic classification and histological type.

Results

For morphological criteria, there were 21 cases of Type I (36%), 15 Type II (26%), 9 Type III (15%), five Type IV (9%), five Type V (9%), and three Type VI (5%). For color Doppler criteria, there were 47 cases classified as hypervascular (81%), eight as hypovascular (14%), and three as avascular (5%). Most of the SGCTs were divided into types I and II; the NSGCTs into types III, IV, and V; the LHTs into only type II; and the TPSs into type VI.

Conclusion

We established a sonographic classification of testicular tumors with various histological types. This sonographic classification is potentially useful for estimating the histological type of testicular tumors.

     

Intratesticular varicocele: an easy diagnosis but unclear physiopathologic characteristics.

OBJECTIVE: Intratesticular varicocele (ITV) is an uncommon sonographic finding with controversial data concerning its prevalence and physiopathologic characteristics. The goal of this study was to determine the prevalence of ITV in a urogenital imaging department and to describe its sonographic features. METHODS: All identified cases of ITV were prospectively collected in the same imaging department. RESULTS: Intratesticular dilated veins (>2 mm) with a positive response to the Valsalva maneuver were referred to as ITV. Nine cases of ITV were detected in 8 patients (mean age, 60 years; range, 30-85 years) in a series of 1832 scrotal sonographic examinations performed over 5 years (0.4%). A history of homolateral scrotal surgery was found in 5 cases. In most cases, ITV was left sided (6/9) and located in the mediastinum testis (6/9) with associated extratesticular varicocele (8/9) and testicular hypotrophy (7/9). Five of the 7 hypotrophic testes had other causes of hypotrophy. CONCLUSIONS: Although variations do exist in the sonographic appearance of ITV, its specific sonographic and Doppler appearance should enable the radiologist to obviate further study. Intratesticular varicocele is often associated with ipsilateral testicular atrophy, but whether it is a cause or a consequence of testicular atrophy remains unclear.     

乳腺恶性叶状肿瘤的临床与超声特征研究

目的研究乳腺恶性叶状肿瘤（MPT）临床、超声声像图表现及其病理特征,为恶性叶状肿瘤诊断提供依据。方法对手术病理证实的12例恶性叶状肿瘤患者的临床、超声声像图表现、病理形态学特征、肿瘤复发转移与临床预后进行总结分析。结果 12例恶性叶状肿瘤患者超声声像图表现：肿瘤大小及部位：12例患者13个恶性叶状肿瘤位于左侧乳腺4例,右侧乳腺8例,其中8个肿瘤最大径≥5.0cm,5个肿瘤〈5.0cm。肿瘤形态及边界：13个恶性叶状肿瘤10个呈分叶状,2个形态不规则;11个边界清晰,2个边界不清晰。内部回声及后方回声：11个内部回声不均匀,2个内部回声均匀;9个后方回声增强,6个内部伴无回声。内部钙化：1个肿瘤内出现粗大钙化,12个内部无钙化。血流分级：彩色多普勒血流成像示2个肿瘤表现为Ⅰ级血流,3个表现为Ⅱ级血流,8个表现为Ⅲ级血流。第1次手术方式：12例患者中6例采用单纯肿瘤切除活检术,2例采用肿瘤扩大切除术,4例采用乳房切除术。术后临床随访结果：术后随访20～155个月,平均（69.9±46.4）个月,其中4例肿瘤局部复发（1例复发1次,1例复发2次,1例复发3次,1例复发15次,3例第1次手术为肿瘤单纯切除术,1例第1次手术为全乳切除术）,1例出现肺部转移。结论肿瘤体积较大,呈实性分叶状,内部回声不均伴无回声,血流丰富,易局部复发为乳腺恶性叶状肿瘤的临床超声表现。     

Sonographic appearance of a testicular yolk sac tumor in a 2-year-old boy

Yolk sac tumor (YST) of testis is the most common of all childhood testicular malignancies. We report a case of testicular YST in a 2-year-old boy. The tumor appeared sonographically as an ovoid, homogeneous, well-circumscribed, isoechoic, solid testicular mass with good sound-through transmission and increased internal vascularity on color Doppler imaging. The serum alpha-fetoprotein level was 4,396 ng/ml. Pathological examination confirmed YST at at stage I. Although the sonographic appearance of YST of the testis is nonspecific, the diagnosis is achievable in clinical practice on the combination of elevated serum alpha-fetoprotein level and sonograms depicting a solid testicular hypervascular mass.