腮腺基底细胞瘤超声和临床特征研究及与常见良性肿瘤的鉴别

发布时间：2018-06-02 04:43

本文选题：基底细胞瘤 + 多形性腺瘤　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:探讨腮腺基底细胞瘤的临床表现、常规超声及超声造影特征,寻求其诊断价值,获取与腮腺多形性腺瘤及腺淋巴瘤的鉴别诊断要点。方法:收集2011年1月至2014年12月经手术病理证实为腮腺基底细胞瘤及多形性腺瘤、腺淋巴瘤的患者临床表现、常规超声及超声造影资料,分别分析基底细胞瘤在这三方面的特征及与另外两种肿瘤的差异。临床资料包括:年龄(≥50岁/50岁)、性别(男性/女性)、吸烟史(有/无)、触诊情况(较软/较硬)、消长史(有/无);常规超声资料包括:肿瘤位置(单侧/双侧、左侧/右侧)、达深叶(有/无)、最大径(3.0cm/≥3.0cm)、边界(清楚/不清楚)、内部回声(低弱回声/混合回声)、分叶状改变(有/无)、网格样回声(有/无)、后方回声增强(有/无)、液性暗区(有/无)、液性暗区范围(大/小)、钙化(有/无)、周边淋巴结(有/无)、内部血流丰富程度(Alder半定量分级,0-I级/Ⅱ-Ⅲ级);超声造影资料包括:团块始增强时相(早/同步或晚增强)、始增强部位(周边先增强/中心先增强或弥漫性增强)、达峰增强程度(高/低增强)、增强均匀程度(均匀性/不均匀性增强)、周边环状增强(有/无)、周边结节状增强(有/无)、无增强区(有/无)、增强后边界(清楚/不清楚)、增强后范围(有变化/无变化)、增强后消退(较快/较慢)。结果:2011年1月至2014年12月纳入108例患者112个病灶,其中基底细胞瘤14例患者14个病灶,多形性腺瘤59例患者61个病灶,腺淋巴瘤35例患者37个病灶。经过对三组肿瘤临床资料分析发现,基底细胞瘤组发病年龄一般≥50岁,触诊质地较软,与多形性腺瘤组比较有显著统计学差异(P0.05),与腺淋巴瘤组比较无统计学差异;另外,基底细胞瘤组多发于女性患者,无吸烟史及消长史,与腺淋巴瘤组比较有显著统计学差异(P0.05),而与多形性腺瘤组比较无统计学差异。分析常规超声发现,基底细胞瘤组全部发生于单侧,其中71.4%(10/14)发生于左侧,另外85.7%(12/14)最大径3.0cm,35.7%(5/14)呈混合回声,无一例显示网格样回声,42.8%(6/14)可见液性暗区且液性暗区范围较大者占28.6%(4/14),57.1%(8/14)呈现血流信号Ⅱ-Ⅲ级;多形性腺瘤组中,全部发生于单侧,其中37.7%(23/61)发生于左侧,另外26.2%(16/61)最大径3.0cm,3.3%(2/61)呈混合回声,1.6%(1/61)可显示网格样回声,18.0%(11/61)可见液性暗区且液性暗区范围较大者占3.3%(2/61),16.4%(10/61)呈现血流信号Ⅱ-Ⅲ级;腺淋巴瘤组中,59.5%(22/37)发生于左侧,67.6%(25/37)最大径3.0cm,24.3%(9/37)呈混合回声,29.7%(11/37)可显示网格样回声,40.5%(15/37)可见液性暗区且液性暗区范围较大占16.2%(6/37),32.4%(12/37)呈现血流信号Ⅱ-Ⅲ级。基底细胞瘤组与多形性腺瘤组在肿瘤发生位置、最大径、内部回声、液性暗区及液性暗区范围、血流信号之间具有显著统计学差异(P0.05),与淋巴瘤组仅在有无网格样回声表现上有显著统计学差异(P0.05)。分析超声造影发现,基底细胞瘤组中,78.6%(11/14)呈现早增强、高增强模式,42.9%(6/14)可见“无增强区”,14.3%(2/14)周边可见结节状增强,21.4%(3/14)消退较快;多形性腺瘤组中,18.0%(11/61)呈现早增强模式,27.9%(17/61)呈现高增强模式,18.0%(11/61)可见“无增强区”,无一例呈现周边结节状增强,3.3%(2/61)消退较快;腺淋巴瘤组中,54.1%(20/37)呈现早增强模式,86.5%(32/37)呈现高增强模式,54.1%(20/37)可见“无增强区”,无一例呈现周边结节状增强,无一例呈现消退较快。基底细胞瘤组与多形性腺瘤组在始增强时相、达峰增强程度、“无增强区”、周边可见结节状增强、消退情况有显著统计学差异(P0.05),与腺淋巴瘤比较仅在增强后消退表现上有统计学差异(P0.05)。结论:基底细胞瘤在临床表现、常规超声及超声造影表现上具有一定的特征性,比如多发于年龄≥50岁女性患者,触诊较软,左侧发生,最大直径3.0cm,可呈混合回声,可见液性暗区且液性暗区范围相对较大,血流信号较丰富,超声造影后多呈现早增强、高增强模式,“无增强区”,周边可见结节状增强,消退较快。掌握这些要点可以提高基底细胞瘤诊断的准确性,同时也为外科医生提供更准确的信息。另外,基底细胞瘤这些特征与多形性腺瘤比较多有明显差异性,鉴别两者较为容易;与腺淋巴瘤比较,除了在发病性别、吸烟史、消长史、无网格样回声、消退表现有一定差异性,其他均无明显差异性,鉴别有很大困难。
[Abstract]:Objective: To explore the clinical features of parotid basilar tumor, the characteristics of conventional ultrasound and ultrasound contrast, and to seek the diagnostic value of parotid pleomorphic adenoma and adenoma. Methods: to collect the diagnosis of parotid pleomorphic adenoma and adenoma from January 2011 to 2014. The surgical pathology proved to be parotid basal cell tumor, pleomorphic adenoma, adenoma Clinical features, conventional ultrasound and ultrasound contrast data, respectively, to analyze the characteristics of the three aspects of basilar tumor and the difference with the other two types of tumors. The clinical data include: age (older than 50 years old, /50 years), sex (male / female), smoking history (/ no), palpation (soft / hard), history of extinction (or no); conventional ultrasound data including tumor location (unilateral / bilateral, left / right), maximum diameter (3.0cm/ > 3.0cm), boundary (clear / unclear), internal echo (low echo / mixed echo), lobulated (/ no), mesh like echo (/ no), posterior echo enhancement (/ no), liquid dark area (/ no), liquid dark area (large / small), calcified (/ no), peripheral lymph node (there is / no), internal blood flow abundance (Alder semi quantitative, 0-I / II - III); contrast-enhanced phase (early / synchronous or late enhancement), initial enhancement (first enhancement / center enhancement or diffuse enhancement), peak enhancement (high / low enhancement), enhancement of uniformity (uniformity / inhomogeneity enhancement) Edge ring enhancement (with / without), peripheral nodular enhancement (with / no), no enhanced area (/ no), enhanced posterior border (clear / unclear), enhanced post (change / no change), and enhanced postoperative regression (faster / slower). Results: from January 2011 to December 2014, 108 patients were included in 112 lesions, of which 14 cases of basal cell tumor were 14, pleomorphic There were 61 lesions in 59 cases of adenoma and 37 lesions in 35 cases of adenoma. After analysis of the clinical data of three groups of tumors, it was found that the onset age of the basal cell tumor group was generally more than 50 years old and the palpation was softer than that of the pleomorphic adenoma group (P0.05), and there was no statistical difference between the adenoma group and the adenoma group; in addition, the basal cell tumor was the basal cell tumor. The group was mostly in female patients, no smoking history and history of extinction. There was a significant difference between the group and the adenoma group (P0.05), but there was no statistical difference between the group and the pleomorphic adenoma group. The analysis of conventional ultrasound showed that the basal cell tumor group was all unilateral, of which 71.4% (10/14) occurred on the left side, and the other 85.7% (12/14) was 3.0cm, 35.7% (5/14). There was a mixed echo, no case of grid like echo, 42.8% (6/14) visible liquid dark area and a large range of liquid dark area accounted for 28.6% (4/14), 57.1% (8/14) showed blood flow signal II - III; in the multiform adenoma group, all occurred on one side, of which 37.7% (23/61) was born on the left, the other 26.2% (16/61) maximum diameter 3.0cm, 3.3% (2/61) mixed echo, 1 .6% (1/61) can display mesh like echo, 18% (11/61) visible liquid dark area and 3.3% (2/61) with large liquid dark area range, 16.4% (10/61) showing blood flow signal II - III; 59.5% (22/37) in adeno Lymphoma Group, 67.6% (25/37) maximum diameter 3.0cm, 24.3% (9/37) mixed echo, 29.7% (11/37) can display mesh like echo, 40.5% (15/37). There were 16.2% (6/37) and 32.4% (12/37) in the dark area of liquid and liquid dark area, and the location of the tumor in the basal cell tumor group and the pleomorphic adenoma group, the maximum diameter, the internal echo, the dark area and the dark area of the liquid, and the significant difference between the blood flow signals (P0.05), only in the lymphoma group. There were significant statistical differences in the echo performance of the grid like (P0.05). Analysis of ultrasonography showed that 78.6% (11/14) in the basal cell tumor group showed early enhancement, high enhancement pattern, 42.9% (6/14) visible "no enhancement zone", 14.3% (2/14) peripheral visible nodular enhancement, 21.4% (3/14) subsiding faster; 18% (11/61) in the pleomorphic adenoma group had an early enhancement model. 27.9% (17/61) showed a high enhancement pattern, 18% (11/61) showed "no enhancement area", no case of peripheral nodular enhancement, 3.3% (2/61) subsided faster, 54.1% (20/37) showed early enhancement pattern in adeno Lymphoma Group, 86.5% (32/37) showed high enhancement pattern, 54.1% (20/37) showed "no enhancement area", no case showed peripheral nodular enhancement, no case. One case showed a rapid regression. The basal cell tumor group and the pleomorphic adenoma group were in the initial phase, the peak enhancement degree, "no enhancement area", the peripheral nodular enhancement, the regression situation had significant statistical difference (P0.05). Compared with the adenoma, there was a statistical difference between the enhancement and the retrogression (P0.05). Conclusion: basal cell tumor is in the face. Bed performance, conventional ultrasound and ultrasound contrast show a certain characteristic, such as the age of more than 50 years of age more than 50 years old female patients, palpation soft, the left, the largest diameter, the maximum diameter, can be mixed echo, visible liquid dark area and a relatively large liquid dark area, the blood flow signal is more abundant, after ultrasound contrast in the early enhancement, high enhancement pattern "No enhancement area", the peripheral visible nodular enhancement and rapid decline. Mastery of these points can improve the accuracy of the diagnosis of basal cell tumor and provide more accurate information for the surgeon. In addition, the characteristics of basal cell tumor are much different from those of pleomorphic adenomas, which are easier to distinguish between them; compared with adenomas. Besides, there was a certain difference in the history of smoking, history of growth and decline, meshless echo, and regression in addition to the onset of sex.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.8;R445.1

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