摘要
目的分析少见部位原发性类癌的影像表现及病理表现,加强对该病的认识。方法回顾性分析经手术后病理证实的10例原发性类癌的临床、影像及病理资料,术前6例行CT平扫及增强,2例行MRI平扫及增强,1例仅行CT增强,另有1例行CT增强及MRI平扫。结果10例少见部位原发类癌,男7例,女3例。鼻腔、喉部、膀胱各1例,肾脏3例,纵隔4例(均来源于胸腺),其中2例为非典型类癌,其余8例均为典型类癌。1例鼻腔内原发类癌(非典型)MRI上表现为右侧鼻腔内不规则软组织肿块,侵犯右侧中下鼻甲、翼腭窝、右侧上颌窦、右侧筛窦以及右侧中下鼻甲,肿块呈不均匀强化。1例喉部原发类癌CT增强仅见会厌软组织稍增厚,MRI平扫示右侧声带不均匀增厚,喉腔内不规则小结节。4例纵隔原发类癌(其中1例为非典型类癌),CT平扫均表现为边界较清、密度较均匀软组织,1例内见钙化,增强扫描示3例(2/3均匀强化)轻中或中度强化,1例(1/3)明显均匀强化。3例肾脏原发类癌,平扫2例呈囊实性,1例呈实性,实性肿块患者已出现腹膜后淋巴结转移、肝内转移,3例内均见钙化;增强扫描示2例囊实性肿块实性成分较明显不均匀延迟性强化,囊变区不强化,1例实性肿块轻度延迟性强化。1例膀胱原发类癌表现为左侧膀胱三角区肿块,呈囊实性以广基底与膀胱相连,增强扫描病灶明显环形强化,囊变区不强化。结论鼻腔、喉部、膀胱、肾脏、纵隔等部位的原发类癌很罕见,影像学上多以实性肿块或囊实性肿块形式存在,其中鼻腔类癌软组织肿块多呈填充样改变;喉部类癌一般体积小,容易出现颈部淋巴结转移;纵隔内类癌多为轻中度强化,肿块内明显强化的线样血管或可作为纵隔胸腺类癌的提示;肾脏原发类癌一般肿块较大,常出现坏死、囊变,钙化相对少见,多呈实性或囊实性,增强扫描实性肿块或肿块实性部分可有延时性强化;膀胱类癌多发生于膀胱三角区/侧壁不规则软组织肿块,增强可有强化。当鼻腔、喉部、纵隔、肾脏、膀胱等部位影像学出现以上表现,尤其是临床上出现典型类癌综合征时,可以提示类癌的可能,但最终确诊依赖病理及免疫组织化学。
Objective To analyze the imaging and pathological manifestations of primary carcinoid tumors in the rare regions and to enhance the understanding of this disease.Methods The clinical,imaging and pathological data of 10 cases of primary carcinoid confirmed by postoperative pathology were retrospectively analyzed.6 cases examined with CT plain scan and enhancement,2 cases imaged with MRI plain scan and enhancement,1 case examined with CT enhancement alone,and 1 case received both CT enhancement and MRI plain scan.Results There were 10 cases of primary carcinoid in rare sites,including 7 males and 3 females.There was 1 case of nasal cavity,larynx,bladder,3 cases of kidney and 4 cases of mediastinum,among which 2 cases were atypical carcinoid and the remaining 8 cases were typical carcinoid.1 case of primary carcinoid(atypical)MRI in the nasal cavity showed irregular soft tissue mass in the right nasal cavity,invading the right middle and lower turbinate,pterygopalatine fossa,right maxillary sinus,right ethmoid sinus and right middle and lower turbinate.And the mass was unevenly strengthened.1 case of primary carcinoid CT enhancement in the larynx showed only a slight thickening of the soft tissue of the epiglottis.The MRI plain scan showed uneven thickening of the right vocal cord and irregular small nodules in the larynx.4 cases of primary mediastinal carcinoid(all from the thymus),1 of which were atypical carcinoid,and all 4 cases of CT plain scan showed clearer border and uniform soft tissue,1 of which showed calcification,3 cases(2/3 uniform enhancement)showed mild or moderate enhancement,and 1 case showed obvious uniform enhancement.3 cases with primary renal carcinoid,plain scan showed 2 cases with solid-cystic mass and 1 case with solid mass.A patient with solid mass developed retroperitoneal lymph node metastases and intrahepatic metastases,and calcification was observed in all 3 cases.Enhancement scan showed that 2 cases of solid-cystic mass had significantly non-uniform delayed enhancement of solid components,no enhancement of cystic area,and 1 case of solid mass had slightly delayed enhancement.1 case of primary bladder carcinoid showed a mass of the left side of the bladder.It was cystic and attached to the bladder by a wide base.The enhanced scanning lesions were obviously ring-shaped and the cystic zone was unenhanced.Conclusion Primary carcinoid tumors in rare regions such as nasal cavity,larynx,bladder,kidney and mediastinum were mostly in the form of solid lesions or cystic lesions on imaging.Laryngeal carcinoid is usually small in size and prone to cervical lymph node metastases.Mediastinal carcinoid generally has mild to moderate enhancement and obvious enhancement of linear vessels in the mass may suggest mediastinal thymocarcinoid.The primary carcinoid mass of the kidney is usually large,often showing necrosis,cystic degeneration.Calcification is relatively rare,mostly solid or cystic,enhanced scan solid mass or solid component can produce delayed enhancement.Bladder carcinoid mainly occurs in the trigonal region of the bladder/lateral wall irregular soft tissue mass,with enhancement.When images of nasal cavity,larynx,mediastinum,kidney and bladder show the above manifestations,especially when typical carcinoid syndrome appears in clinical practice,the possibility of carcinoid may be indicated.However,the final diagnosis still needs to rely on pathology and immunohistochemistry.
作者
陈优
何来昌
谭永明
占雅如
黄雨滢
陈静婷
CHEN You;HE Laichang;TAN Yongming(Department of Radiology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,P.R.China)
出处
《临床放射学杂志》
CSCD
北大核心
2020年第8期1548-1553,共6页
Journal of Clinical Radiology
关键词
类癌
体层摄影术
X线计算机
磁共振成像
Carcinoid
Tomography,X-ray computed
Magnetic resonance imaging
作者简介
通讯作者:何来昌
