子宫平滑肌瘤少见生长方式影像学表现

目的:探讨子宫平滑肌瘤少见生长方式影像学表现.方法:收集经手术病理证实寄生性平滑肌瘤6例、静脉内平滑肌瘤病3例、播散性腹膜平滑肌瘤病3例和良性转移性平滑肌瘤2例,分析这些少见生长方式子宫平滑肌瘤的影像学特征.结果:6例寄生性平滑肌瘤发生在盆腔腹膜,与子宫相分隔;6例CT平扫呈等密度,增强呈中度强化;2例MRI与臀肌比较,T1WI/T2WI呈等信号.3例静脉内平滑肌瘤病均有子宫平滑肌瘤病史.1例左肾静脉受累,2例经静脉累及到右心房,1例经右心房累及到右心室;CT示下腔静脉扩张,增强显示血管内和右心腔内充盈缺损,呈"血管内血管"征;2例MRI显示腔静脉扩张,流空效应消失.3例播散性腹膜平滑肌瘤病表现为腹膜多发结节(直径约1-2 cm)2例,腹膜和腹膜后多发大小不等结节和肿块1例.2例良性转移性平滑肌瘤表现肺多发转移灶,1例胸膜受累. 结论:在有子宫平滑肌瘤病史的女性,影像学表现局部病变进展或转移时,应考虑到子宫平滑肌瘤的一些少见生长方式.

Radiological Features of Uterine Leiomyoma with Unusual Growth Patterns

Objective: To explore radiological findings from uterine leiomyoma with unusual growth patterns.Methods: Fourteen cases of uterine leiomyoma with unusual growth patterns confirmed by pathology were analyzed through their imaging features.Results: Six parasitic leiomyomas developed on pelvic peritoneum separated from uterus,which presented isodensity on CT plain scan and moderate enhancement on contrast scan,and the isointensity on T1WI/T2WI compared with gluteus.In the three intravenous leiomyomatoses with the history of uterine leiomyoma,one lesion extended into inferior vena cave(IVC),one lesion extended into the right atrium,and the other one even extended into right ventricular.CT scans presented the distention of IVCs,one of which even with widened left renal vein.Contrast scans showed the filling defects in the IVC and right heart with "vessel in vein" sign.MRI scans indicated IVC dilatation without flow void effect.In three disseminated peritoneal leiomyomatoses,two presented multiple nodules sized from 1 cm to 2 cm on peritoneum and the other one presented multiple tumors intra-extraperitoneum.Two cases metastasized to lung.Conclusion: When the history of uterine leiomyoma presents the focal lesion progressing and metastasizing,such unusual growth patterns from uterine leiomyoma should be considered.