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Sonographic and Clinicopathologic Characteristics of Ovarian Sclerosing Stromal Tumor
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摘要:
目的 探讨卵巢硬化性间质瘤(ovarian sclerosing stromal tumor, OSST)的超声图像及临床病理特征。 方法 回顾性分析1996年3月至2013年9月北京协和医院经手术病理证实的12例OSST患者的临床、病理及影像学表现, 着重对其超声图像特点进行分析。 结果 12例OSST患者中, 8例主诉为月经不规律, 6例患者性激素水平异常, 4例CA125升高。OSST均呈单侧发病, 病灶声像图特点:12例(100%)病灶边界清晰; 10例(83.3%)呈典型分叶状; 7例(58.3%)为囊实性以实性为主结构, 4例(33.3%)为实性结构; 8例(66.7%)实性部分表现为低回声; 12例(100%)病灶实性部分回声不均; 10例(83.3%)内部散在细条状高回声; 11例(91.7%)病灶后方回声衰减; 10例(83.3%)病灶呈丰富规则的血流信号, 多为周边及内部规则血流, 内部血流呈轮辐状向心分布是其特征性表现。 结论 OSST具有特征性的临床表现, 有着与其病理特点相对应的典型超声图像特征, 超声检查对于术前明确诊断可起到重要作用。 Abstract:Objective To investigate the sonographic and clinicopathologic characteristics of the ovarian sclerosing stromal tumor (OSST). Methods The clinical, pathological, and sonographic records of 12 patients with pathologically confirmed OSST between March 1996 and September 2013 were retrospectively reviewed, and the sonographic characteristics of the OSSTs were analyzed. Results Eight of these 12 patients complained of irregular menstruation. Abnormal hormone levels were observed in 6 patients and elevated CA125 in 4 patients. All OSSTs occurred unilaterally. Under the ultrasound, the tumors manifested as lobulated in 10 patients (83.3%), and all the lesions had a sharp border. The tumors were solid with small cystic structures in 7 patients (58.3%) and purely solid in 4 patients (33.3%). For the solid parts, the tumors were hypo-echoic in 8 cases (66.7%) and heterogeneously echogenic in 12 cases (100%). Thin hyper-echoic strips were seen in 10 cases (83.3%) and posterior attenuation in 11 cases (91.7%). The lesions were hyper-vascularized in 10 cases (83.3%), and spoke-like distribution of the blood flow was a unique feature. Conclusions OSSTs have special clinical manifestations, and the ultrasound findings are consistent with their pathological features. Ultrasonography is particularly useful for the preoperative diagnosis of OSSTs. -
Key words:
- ovarian sclerosing stromal tumor /
- sex cord stromal tumor /
- ovarian neoplasm /
- ultrasound
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图 1 49岁女性，G0P0，因月经不规律就诊，血清雌二醇876.8 pg/ml，血清CA125 81.4 U/ml，行全子宫加双附件切除术，术后病理诊断符合左卵巢硬化性间质瘤
A.术前超声检查提示左侧卵巢见一6.9 cm×5.7 cm×4.7 cm分叶状低回声，边界清，内小无回声及小细条状高回声；B.彩色多普勒显像示内部血流呈向心性分布；C.术前增强CT检查显示周边增强，内部呈轮辐状增强(箭头)；D.病理切片镜下显示肿瘤细胞呈不规则分布，小片状的水肿和透明变性区域使瘤体分割成假小叶结构，瘤细胞细胞浆呈嗜酸性染色，细胞核可见偏心现象，部分类似印戒细胞，核内可见水泡，并有细胞核深染现象，可见扩张的薄壁小血管
表 1 12例卵巢硬化性间质瘤病灶超声图像特点
声像图表现 例数 百分比(%) 形态 规则(类圆、椭圆) 2 16.7 典型分叶状 10 83.3 其他不规则形状 0 0 边界 清晰 12 100 不清晰 0 0 内部回声 囊实性，囊性为主 1 8.3 囊实性，实性为主 7 58.3 实性 4 33.3 实性部分回声水平 中高回声 1 8.3 等回声 3 25 低回声 8 66.7 内部回声均匀程度 均匀 0 0 不均匀 12 100 内部细条状高回声 有 10 83.3 无 2 16.7 后方回声 增强 11 91.7 无增强、无衰减 1 8.3 衰减 0 0 彩色血流信号 血流不丰富 2 16.7 血流丰富且规则 10 83.3 血流丰富且不规则 0 0 
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