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摘要:
目的 探讨超声在膀胱副神经节瘤(paraganglioma of urinary bladder, PUB)中的诊断价值。 方法 回顾性分析2002年10月至2013年6月北京协和医院经病理证实的13例PUB的临床表现及超声声像图表现。13例患者中男性5例, 女性8例, 年龄14~76岁, 平均41.7岁。 结果 9例(69.2%)PUB患者临床表现为排尿出现头疼、心悸、出汗及血压增高四联症; 12例(92.3%)尿儿茶酚胺增高; 4例(30.8%)在0.5~3年内发生复发。13例PUB超声声像图共发现16个病灶, 病灶大小1.2~7.5 cm; 病灶形态规则9个(56.3%), 不规则7个(43.8%); 病灶边界清晰9个(56.3%), 其中5个(31.3%)可见连续完整的膀胱黏膜, 不清晰7个(43.8%); 病灶回声均为低回声, 1个(6.3%)内部可见巢样结构。彩色多普勒血流显像示血流丰富12个(75%), 点条状血流2个(12.5%), 未见血流信号2个(12.5%)。4例(30.8%)出现其他脏器受累。 结论 PUB超声声像图表现具有一定的特征性, 结合其临床特征有助于鉴别诊断, 并在判断预后及术后随诊中有重要作用。 Abstract:Objective To explore the role of ultrasound in diagnosis of paraganglioma of urinary bladder(PUB). Methods The clinical data and urinary bladder sonographic findings of 13 patients(8 females and 5 males, aged 14-76 years) with pathologically confirmed PUB in Peking Union Medical College Hospital from October 2002 to June 2013 were retrospectively analyzed. Results Among these 13 patients, 9(69.2%) had headache, palpitation, sweating, and hypertension with micturition, 12(92.3%) had elevated urinary catecholamine, and 4(30.8%) experienced recurrence within 0.5 to 3 years. The diameters of 16 lesions(including 10 solitary lesions and 3 multiple lesions) found in these 13 patients were 1.2-7.5 cm. Nine lesions were morphologically regular and 7(43.8%) were irregular. The margins were well-defined in 9 lesions(56.3%), with continuous bladder mucosa found in 5 lesions(31.3%), and were poorly-defined in 7 lesions(43.8%). All the lesions were hypoechoic, and nest-like structure was seen inside one lesion(6.3%). Color Doppler imaging showed rich blood flow signals in 12 lesions(75%), spot-and strip-like blood flow signals in 2 lesions(12.5%), and no blood flow signal in 2 lesions(12.5%). Involvement of other organs was reported in 4 cases(30.8%). Conclusions The sonographic findings of PUB are somehow unique. When combined with clinical features, it is helpful in the differentiation diagnosis, prediction of treatment outcome, and follow-up. -
Key words:
- bladder tumor /
- paraganglioma /
- pheochromocytoma /
- ultrasound diagnosis
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图 1 58岁女性膀胱副神经节瘤患者的病理及超声表现
A.膀胱副神经节瘤镜下表现(HE染色，×100)，见多边形上皮样肿瘤细胞，排列呈巢团状, 细胞巢之间有明显/丰富的血窦分隔；B.膀胱横切面二维超声显示膀胱前壁低回声，内可见条索状中高回声交织成网状
图 2 30岁男性患者的膀胱横切面超声检查，患者因间断排尿后头痛、心悸、大汗及血压增高2年就诊，手术病理示膀胱副神经节瘤
A.二维超声示膀胱左后壁见低回声，大小3.1 cm×3.1 cm×2.7 cm，形态规则，边界清晰，可见连续的膀胱黏膜层(箭头)；B.彩色多普勒血流显像示低回声内见丰富血流信号
图 3 25岁女性患者的膀胱纵切面超声检查，患者因血尿就诊，手术病理显示膀胱副神经节瘤
A.二维超声示膀胱后壁见低回声，大小4.7 cm×4.1 cm×4.5 cm，形态不规则，内部回声不均匀，可见数处强回声(箭头)；B.彩色多普勒血流显像示低回声内见丰富血流信号，阻力指数为0.46
表 1 膀胱副神经节瘤的超声影像学表现
病例 性别 年龄
(岁)病灶
数目病灶
位置病灶大小
(cm)病灶
回声有无强
回声形态 边界 膀胱壁黏膜
层完整血流
信号其他脏器受累情况 1 女 46 1 前壁 1.3×0.6 低回声 无 规则 清晰 可见 丰富 2 女 43 2 侧壁 5.6×4.2
1.4×1.1低回声
低回声无
无不规则
不规则不清晰
不清晰未见
未见丰富
丰富膀胱病灶突破浆膜层, 出现局部盆腔浸润 3 男 65 1 侧壁 1.2×1.0 低回声 无 规则 清晰 可见 点条状 4 男 30 1 后壁 3.1×2.7 低回声 无 规则 清晰 可见 丰富 5 女 37 2 后壁及侧壁 4.4×1.6
2.0×1.8低回声
低回声无
无不规则
不规则不清晰
不清晰未见
未见丰富
丰富膀胱病灶突破浆膜层, 出现局部盆腔浸润 6 男 18 1 侧壁 3.4×2.4 低回声 无 规则 清晰 可见 点条状 腹膜后出现病灶 7 男 36 1 前壁 2.1×2.0 低回声 无 规则 清晰 未见 未见 8 女 76 2 侧壁 7.5×5.9
2.4×1.5低回声
低回声无
有不规则
不规则不清晰
不清晰未见
未见丰富
丰富9 女 55 1 前壁 1.4×1.2 低回声 无 规则 清晰 未见 丰富 10 男 14 1 三角区 5.3×3.6 低回声 无 规则 清晰 未见 丰富 11 女 25 1 三角区 4.7×4.1 低回声 有 不规则 不清晰 未见 丰富 12 女 58 1 前壁 5.9×1.7 低回声 无 规则 清晰 未见 丰富 左侧髂血管旁淋巴结肿大, 肝脏实性占位 13 女 39 1 三角区 1.2×1.0 低回声 无 规则 清晰 可见 未见 
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