多层螺旋CT在睾丸良恶性肿瘤的诊断及鉴别诊断价值研究
发布时间：2019-03-27 19:11
【摘要】：目的：探讨多层螺旋CT在睾丸原发肿瘤的诊断、鉴别诊断及分期中的价值。 材料与方法：回顾性分析经手术和病理证实的48例睾丸肿瘤的组织病理、临床特点和CT表现。所有48例睾丸肿瘤患者均行MSCT平扫及增强扫描检查，平扫层厚2mm，层距2mm；增强扫描层厚1mm采集，层距1mm。对病灶进行常规薄层重建，获取的薄层横断图像通过工作站的后处理技术，重建MPR、VR图像。48例睾丸肿瘤中精原细胞瘤13例、混合性生殖细胞瘤9例、淋巴瘤14例、卵黄囊瘤2例、良性畸胎瘤2例、腺瘤样瘤与表皮样囊肿各2例，胚胎性癌、恶性畸胎瘤、平滑肌瘤及髓外浆细胞瘤各1例。 结果：MSCT检出所有48例睾丸肿瘤，均为单侧发病，其中左侧19例、右侧29例，其中45例平扫时表现为睾丸肿大，35例境界清楚，41例恶性肿瘤平均直径4.6±1.3cm，，7例良性肿瘤平均直径2.4±0.8cm，统计检验水准α以0.05估计，二者差异有统计学意义(t=4.351，P＜0.05)，但良恶性肿瘤的MSCT强化程度差异无统计学意义(t=0.013，P＞0.05)。在41例睾丸恶性肿瘤中，精原细胞瘤与混合性生殖细胞瘤强化程度无显著性差异(t=-1.578，P＞0.05)，混合性生殖细胞瘤与淋巴瘤强化程度差异无统计学意义(t=0.528，P＞0.05)，但精原细胞瘤与淋巴瘤强化程度差异有显著性差异(t=-2.686，P＜0.05)，淋巴瘤与混合性生殖细胞瘤的好发年龄段比较，二者差异具有统计学意义(t=-8.196，P＜0.05)。卵黄囊瘤多为5岁以下儿童发病，且患者血清AFP水平明显增高；MSCT平扫2例良性畸胎瘤含钙化、脂肪成分,具有特征性；腺瘤样瘤平扫病灶内密度均匀，未见钙化及坏死灶，增强扫描病变无明显强化。其余不同病理类型的睾丸肿瘤有其各自的影像或临床特点。41例恶性肿瘤中31例MSCT扫描未发现肿大淋巴结，3例合并腹股沟或腹膜后淋巴结肿大，1例合并锁骨下淋巴结肿大，分别提示临床I、II、III期，与手术病理结果相符。 结论：睾丸肿瘤的MSCT表现有一定特征性，且MSCT能显示淋巴结及远处转移情况，对睾丸肿瘤的诊断和临床分期具有重要的价值。结合临床资料与MSCT检查对区分各种睾丸肿瘤，尤其是区分肿瘤的良恶性、肿瘤术前分期和术后随访方面具有重要的意义。
[Abstract]:Objective: to evaluate the value of multi-slice spiral CT in the diagnosis, differential diagnosis and staging of primary testicular tumors. Materials and methods: the histopathology, clinical features and CT findings of 48 cases of testicular tumors proved by surgery and pathology were retrospectively analyzed. All 48 cases of testicular tumors were examined by MSCT plain scan and contrast-enhanced scanning, the thickness of plain scan was 2 mm and the interval of layer was 2 mm, and the thickness of enhanced scan layer was collected by 1mm, and the slice distance was 1 mm. The MPR,VR images were reconstructed by workstation post-processing technique. Among 48 testicular tumors, 13 cases were spermatogonia, 9 cases were mixed germ cell tumor, 14 cases were lymphoma, and the other 48 cases of testicular tumor were diagnosed as spermatogonia (n = 13), mixed germ cell tumor (n = 9), lymphoma (n = 14). There were 2 cases of yolk sac tumor, 2 cases of benign teratoma, 2 cases of adenoma-like tumor and 2 cases of epidermoid cyst, 1 case of embryonic carcinoma, 1 case of malignant teratoma, 1 case of leiomyoma and 1 case of extramedullary plasmacytoma. Results: all 48 cases of testicular tumors were detected by MSCT, including 19 cases on the left side and 29 cases on the right side. Among them, 45 cases showed testicular enlargement on plain scan, 35 cases had a clear boundary, 41 cases had a mean diameter of 4.6 卤1.3 cm, and the average diameter of 41 cases with malignant tumors was 4.6 卤1.3 cm. The mean diameter of 7 benign tumors was 2.4 卤0.8 cm. The statistical test level 伪 was estimated by 0.05. The difference was statistically significant (t = 4.351, P < 0.05), but there was no significant difference in MSCT enhancement between benign and malignant tumors (t = 0.013, P < 0.01). (P > 0.05). In 41 cases of testicular malignant tumors, there was no significant difference between spermatogonia and mixed germ cell tumors (t = 1.578, P > 0.05). There was no significant difference in enhancement between mixed germ cell tumor and lymphoma (t = 0.528, P > 0.05), but there was significant difference between spermatogonia and lymphoma (t = 2.686, P < 0.05). There was a significant difference in the age between lymphoma and mixed germ cell tumor (t = 8.196, P < 0.05). Yolk sac tumor mostly occurred in children under 5 years old, and the level of serum AFP in the patients was significantly higher than that in the control group, MSCT plain scan showed calcification and fat in 2 cases of benign teratoma, and it was characteristic. There was no calcification and necrosis on plain scan of adenoma-like tumor, and no obvious enhancement was found in contrast-enhanced scan. Other different pathological types of testicular tumors had their own imaging or clinical features. Among 41 cases of malignant tumors, 31 cases had no enlarged lymph nodes on MSCT scan, 3 cases had enlarged inguinal or retroperitoneal lymph nodes, and 1 case had subclavian lymph nodes enlargement. The clinical stage I, II, III were consistent with the results of operation and pathology. Conclusion: the MSCT features of testicular tumors are characteristic, and MSCT can show lymph nodes and distant metastasis, which is of great value in the diagnosis and clinical staging of testicular tumors. Combined with clinical data and MSCT examination, it is of great significance to distinguish various testicular tumors, especially between benign and malignant tumors, preoperative staging and postoperative follow-up.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R737.21;R730.44
本文编号：2448476
[Abstract]:Objective: to evaluate the value of multi-slice spiral CT in the diagnosis, differential diagnosis and staging of primary testicular tumors. Materials and methods: the histopathology, clinical features and CT findings of 48 cases of testicular tumors proved by surgery and pathology were retrospectively analyzed. All 48 cases of testicular tumors were examined by MSCT plain scan and contrast-enhanced scanning, the thickness of plain scan was 2 mm and the interval of layer was 2 mm, and the thickness of enhanced scan layer was collected by 1mm, and the slice distance was 1 mm. The MPR,VR images were reconstructed by workstation post-processing technique. Among 48 testicular tumors, 13 cases were spermatogonia, 9 cases were mixed germ cell tumor, 14 cases were lymphoma, and the other 48 cases of testicular tumor were diagnosed as spermatogonia (n = 13), mixed germ cell tumor (n = 9), lymphoma (n = 14). There were 2 cases of yolk sac tumor, 2 cases of benign teratoma, 2 cases of adenoma-like tumor and 2 cases of epidermoid cyst, 1 case of embryonic carcinoma, 1 case of malignant teratoma, 1 case of leiomyoma and 1 case of extramedullary plasmacytoma. Results: all 48 cases of testicular tumors were detected by MSCT, including 19 cases on the left side and 29 cases on the right side. Among them, 45 cases showed testicular enlargement on plain scan, 35 cases had a clear boundary, 41 cases had a mean diameter of 4.6 卤1.3 cm, and the average diameter of 41 cases with malignant tumors was 4.6 卤1.3 cm. The mean diameter of 7 benign tumors was 2.4 卤0.8 cm. The statistical test level 伪 was estimated by 0.05. The difference was statistically significant (t = 4.351, P < 0.05), but there was no significant difference in MSCT enhancement between benign and malignant tumors (t = 0.013, P < 0.01). (P > 0.05). In 41 cases of testicular malignant tumors, there was no significant difference between spermatogonia and mixed germ cell tumors (t = 1.578, P > 0.05). There was no significant difference in enhancement between mixed germ cell tumor and lymphoma (t = 0.528, P > 0.05), but there was significant difference between spermatogonia and lymphoma (t = 2.686, P < 0.05). There was a significant difference in the age between lymphoma and mixed germ cell tumor (t = 8.196, P < 0.05). Yolk sac tumor mostly occurred in children under 5 years old, and the level of serum AFP in the patients was significantly higher than that in the control group, MSCT plain scan showed calcification and fat in 2 cases of benign teratoma, and it was characteristic. There was no calcification and necrosis on plain scan of adenoma-like tumor, and no obvious enhancement was found in contrast-enhanced scan. Other different pathological types of testicular tumors had their own imaging or clinical features. Among 41 cases of malignant tumors, 31 cases had no enlarged lymph nodes on MSCT scan, 3 cases had enlarged inguinal or retroperitoneal lymph nodes, and 1 case had subclavian lymph nodes enlargement. The clinical stage I, II, III were consistent with the results of operation and pathology. Conclusion: the MSCT features of testicular tumors are characteristic, and MSCT can show lymph nodes and distant metastasis, which is of great value in the diagnosis and clinical staging of testicular tumors. Combined with clinical data and MSCT examination, it is of great significance to distinguish various testicular tumors, especially between benign and malignant tumors, preoperative staging and postoperative follow-up.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R737.21;R730.44
【参考文献】
相关期刊论文 前1条
1 张瑾;张连宇;戴景蕊;;睾丸肿瘤的CT诊断[J];癌症进展;2006年05期
本文编号：2448476
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