【摘要】：目的：探討多層螺旋CT在睪丸原發(fā)腫瘤的診斷、鑒別診斷及分期中的價值。 材料與方法：回顧性分析經(jīng)手術和病理證實的48例睪丸腫瘤的組織病理、臨床特點和CT表現(xiàn)。所有48例睪丸腫瘤患者均行MSCT平掃及增強掃描檢查，平掃層厚2mm，層距2mm；增強掃描層厚1mm采集，層距1mm。對病灶進行常規(guī)薄層重建，獲取的薄層橫斷圖像通過工作站的后處理技術，重建MPR、VR圖像。48例睪丸腫瘤中精原細胞瘤13例、混合性生殖細胞瘤9例、淋巴瘤14例、卵黃囊瘤2例、良性畸胎瘤2例、腺瘤樣瘤與表皮樣囊腫各2例，胚胎性癌、惡性畸胎瘤、平滑肌瘤及髓外漿細胞瘤各1例。 結果：MSCT檢出所有48例睪丸腫瘤，均為單側發(fā)病，其中左側19例、右側29例，其中45例平掃時表現(xiàn)為睪丸腫大，35例境界清楚，41例惡性腫瘤平均直徑4.6±1.3cm，，7例良性腫瘤平均直徑2.4±0.8cm，統(tǒng)計檢驗水準α以0.05估計，二者差異有統(tǒng)計學意義(t=4.351，P＜0.05)，但良惡性腫瘤的MSCT強化程度差異無統(tǒng)計學意義(t=0.013，P＞0.05)。在41例睪丸惡性腫瘤中，精原細胞瘤與混合性生殖細胞瘤強化程度無顯著性差異(t=-1.578，P＞0.05)，混合性生殖細胞瘤與淋巴瘤強化程度差異無統(tǒng)計學意義(t=0.528，P＞0.05)，但精原細胞瘤與淋巴瘤強化程度差異有顯著性差異(t=-2.686，P＜0.05)，淋巴瘤與混合性生殖細胞瘤的好發(fā)年齡段比較，二者差異具有統(tǒng)計學意義(t=-8.196，P＜0.05)。卵黃囊瘤多為5歲以下兒童發(fā)病，且患者血清AFP水平明顯增高；MSCT平掃2例良性畸胎瘤含鈣化、脂肪成分,具有特征性；腺瘤樣瘤平掃病灶內(nèi)密度均勻，未見鈣化及壞死灶，增強掃描病變無明顯強化。其余不同病理類型的睪丸腫瘤有其各自的影像或臨床特點。41例惡性腫瘤中31例MSCT掃描未發(fā)現(xiàn)腫大淋巴結，3例合并腹股溝或腹膜后淋巴結腫大，1例合并鎖骨下淋巴結腫大，分別提示臨床I、II、III期，與手術病理結果相符。 結論：睪丸腫瘤的MSCT表現(xiàn)有一定特征性，且MSCT能顯示淋巴結及遠處轉移情況，對睪丸腫瘤的診斷和臨床分期具有重要的價值。結合臨床資料與MSCT檢查對區(qū)分各種睪丸腫瘤，尤其是區(qū)分腫瘤的良惡性、腫瘤術前分期和術后隨訪方面具有重要的意義。
[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 鹵1.3 cm, and the average diameter of 41 cases with malignant tumors was 4.6 鹵1.3 cm. The mean diameter of 7 benign tumors was 2.4 鹵0.8 cm. The statistical test level 偽 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.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R737.21;R730.44

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1 張瑾;張連宇;戴景蕊;;睪丸腫瘤的CT診斷[J];癌癥進展;2006年05期

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