多模态MRI对子宫恶性中胚叶混合瘤的影像学特征与病理对照的分析

目的探讨多模态MRI对子宫恶性中胚叶混合瘤(MMMT)的影像学特征与病理对照的关系,以提高对该病的认识及诊断准确率。方法选取28例经手术病理证实MMMT患者的临床资料,讨论分析临床特点、MRI平扫+联合动态增强(DCE-MRI)及弥散加权像成像DWI(ADC值)检查、病理学及免疫组化检查。结果MMMT癌成分为子宫内膜样腺癌12例,鳞状细胞癌及低分化浆液性腺癌8例,腺鳞癌伴鳞状分化6例,透明细胞腺癌2例;肉瘤成分为内膜间质肉瘤、平滑肌肉瘤、软骨肉瘤、纤维肉瘤、血管肉瘤、横纹肌肉瘤及成骨肉瘤;同源性为25例,以内膜间质肉瘤多见;异源性为3例,软骨肉瘤1例,横纹肌肉瘤及骨肉瘤2例。临床分期:Ⅰ期6例,Ⅱ期7例,Ⅲ期12例,Ⅳ期3例。28例MMMT的部位:原发病灶13例位于宫体内,8例位于宫底,3例位于宫颈,4例位于左侧卵巢。结论MMMT在MRI平扫+DCE-MRI及ADC值检查更能够清晰显示肿瘤的部位、范围、形态、大小、边界、信号特点及强化程度、弥散系数ADC值、淋巴结转移等情况,因此,结合临床特征、病理学及免疫组化检查为临床更进一步早期诊治、疗效评估及术前的准确诊断和制定合理的治疗计划提供更准确的参考依据,以提高患者生存率。

Comparative analysis of imaging features and pathology of malignant mesodermal mixed tumor of uterus based on multimodal MRI

Objective To explore the relationship between the imaging features of multiple modality MRI and the pathological correlation of uterine malignant mesodermal mixed tumor(MMMT),so as to improve the understanding of the disease and the accuracy of diagnosis.Methods Clinical data of 28 patients with MMMT confirmed by surgery and pathology were retrospectively analyzed,and their clinical characteristics,MRI plain scan+combined dynamic enhancement(dce-mri)and diffusion weighted imaging DWI(ADC)examination,pathology and immunohistochemical examination were discussed and analyzed.And carry on the summary analysis.Results MMMT component is endometrial carcinoma adenocarcinoma 12 cases,8 cases of squamous cell carcinoma and poorly differentiated serous adenocarcinoma,adenosquamous carcinoma with squamous differentiation in 6 cases,2 cases of clear cell adenocarcinoma;The components of sarcomas were endometrial stromal sarcoma,leiomyosarcoma,chondrosarcoma,fibrosarcoma,angiosarcoma,rhabdomyosarcoma and osteosarcoma.The homology was 25 cases,most of which were endometrial stromal sarcoma.Heterogenously,there were 3 cases,1 case of chondrosarcoma,2 cases of rhabdomyosarcoma and osteosarcoma.Clinical stage:Ⅰ6 cases,Ⅱperiod 7 cases,Ⅲperiod 12 cases,Ⅳperiod in 3 patients.Location of MMMT in 28 patients:primary lesions were intrauterine in 13,basal in 8,cervix in 3,and left ovary in 4.Conclusion MMMT in joint dynamic enhanced MRI scan+(DCE)MRI t2-weighted and dispersion imaging DWI(ADC)values can check more clearly shows the position and size of tumor,signal characteristic of morphology,size,border,and strengthening,dispersion coefficient of ADC values,lymph node metastasis or distant metastasis,and so on and so forth,as a result,in combination with clinical features,pathology and immunohistochemical examination for clinical early diagnosis and treatment,the curative effect evaluation and further accurate preoperative diagnosis and reasonable treatment plan to provide more accurate reference;To improve patient survival.