子宫肉瘤的超征象与病理学对照研究

目的 探讨子宫肉瘤的彩色多普勒超声声像图特点、病理学基础及超声诊断价值.方法 回顾性分析60例经病理证实的子宫肉瘤超声表现,总结病变数目、位置、形态、边界、液化、结构及内部回声类型等超声征象,结合病理结果探讨病理学基础.结果 超声显示的病灶体积、形态及结构与病理大体一致性好,单发、边界模糊、不规则形态、蜂窝样结构及囊性变是较为典型的超声征象;超声征象与病变组织学类型、分化程度及临床分期密切相关.结论 子宫肉瘤声像图表现与病理组织学特征密切相关,超声对典型子宫肉瘤的诊断具有明确的临床应用价值.     

子宫恶性苗勒管混合瘤的彩色多普勒超声诊断

目的 探讨子宫恶性苗勒氏管混合瘤(MMMT)的彩色多普勒超声特点及病理学基础.方法 回顾性分析10例经病理证实的MMMT的超声表现,总结病变形态学及彩色多普勒血流等超声征象,并探讨其病理学基础.结果 单发、边界模糊、不规则形态、蜂窝样结构、囊性变及丰富血流是MMMT较为典型的超声征象;病变超声征象与组织学分化程度及临床分期密切相关.Logistic回归分析提示病灶血流丰富程度与囊性变的程度和类型呈负相关.结论 MMMT具有较为特征性的声像图表现,其超声征象与组织病理学特征密切相关.     

超声对子宫肉瘤与子宫肌瘤鉴别诊断的临床应用价值

目的 探讨彩色多普勒超声鉴别诊断子宫肉瘤与子宫肌瘤的临床应用价值.方法 分析病理证实的60例子宫肉瘤和150例子宫肌瘤的超声表现,比较二者的病变数目、位置、形态、边界、液化、结构、回声类型及彩色多普勒血流分布等超声征象的差异.结果 子宫肉瘤和肌瘤患者的平均年龄和年龄分布特点的差异有统计学意义(P＜0.05).阴道出血、阴道脱垂物等症状是子宫肉瘤较特异的症状.超声显示病灶体积、形态及内部结构与病理一致性好.肉瘤病灶体积显著大于肌瘤病灶(P＜0.01).典型恶性病变为体积较大的蜂窝样混合回声、边界模糊,形态不规则或分叶状.典型良性病变、为边界清晰的圆或椭圆形漩涡状中低回声,质地均匀,液化灶少见.单发病灶、形态不规则、蜂窝状混合回声和不规则液化结构对恶性病变的诊断意义较大(P＜0.05).彩色多普勒超声显示肉瘤病灶多血流丰富,内部及周边分布可呈"镶嵌样",肌瘤多为规则分布的点条状血流(P＜0.01).部分临床分期、组织学分化程度较好的子宫肉瘤与合并液化坏死的不典型子宫肌瘤的超声征象相互重叠,鉴别诊断较为困难.结论 彩色多普勒超声对子宫肌瘤和子宫肉瘤鉴别诊断有临床应用价值,综合分析灰阶及彩色多普勒征象可提高诊断准确率.     

彩色多普勒超声鉴别子宫肉瘤与子宫肌瘤的价值

目的探讨子宫肉瘤的彩色多普勒超声特点,提高超声检出率。方法回顾性分析病理证实的50例子宫肉瘤与100例子宫肌瘤的声像图特点。结果两组病例在发病年龄、病灶数目、部位、内部回声、边界、形态、血流分布及血流丰富程度等方面有统计学差异(P<0.05)。病灶单发,边界模糊,形态不规则,呈混合性或蜂窝样回声,内部及周边探及Ⅱ~Ⅲ级血流信号,是子宫肉瘤较为典型的超声征象。结论子宫肉瘤声像图特点与子宫肌瘤有较大差异,充分认识子宫肉瘤的声像图特征,多因素综合分析,有利于提高其超声检出率。     

子宫内膜间质肉瘤超声表现的初步探讨

目的：探讨子宫内膜间质肉瘤（ESS）的超声声像图特征及其诊断价值。方法：回顾性分析14例ESS患者二维及彩色多普勒超声结果,并与病理结果对照,分析肿瘤的发生部位、数目、形态、边界、内部回声、血流分布等特征。结果：根据超声所见病变发展不同时期的病灶位置及声像图特点,将其声像图表现分为以下3型：Ⅰ：宫腔型;Ⅱ：宫壁型;Ⅲ：宫腔及宫壁型。结论：通过对该病进行超声分型,并与相应疾病进行鉴别诊断,有助于提高该病的超声诊断准确性。     

子宫内膜病变的超声表现及病理探讨

目的分析子宫内膜病变的超声声像图特征及病理特点,进一步研究子宫内膜病变的超声改变。方法对135例子宫内膜病变声像图特点,结合病理进行综合分析。结果超声诊断子宫内膜息肉诊断符合率91.3%,子宫内膜增生诊断符合率88.7%,子宫内膜癌诊断符合率72.2%。结合病理特点,更有利于对超声的声像图特征进行分析。结论子宫内膜病变的病理学改变使其形成特定的形态特点,也构成声像图上独有的特征,可作为相互鉴别诊断点。     

超声对子宫肉瘤诊断的初步探讨

目的 探讨二维超声对子宫肉瘤的诊断价值。方法 对2例子宫肉瘤的超声声像图进行分析。结果 本组子宫肉瘤表现为子宫明显增大,宫腔内见低回声近似无回声的结节。结论 超声检查结合临床病理可对本病作出诊断。     

子宫内膜间质肉瘤超声误诊分析

目的分析子宫内膜间质肉瘤的超声声像图特点及其误诊原因,以降低超声检查的误诊率。方法回顾性分析经手术及病理学检查证实的6例子宫内膜间质肉瘤的超声声像图特征。结果6例患者中,2例超声图像表现为宫腔内单发的等回声占位,超声诊断内膜病变;2例表现为子宫肌层偏高回声占位,超声误诊为子宫肌瘤;1例表现为子宫肌层不均匀增厚,超声误诊肌腺症;1例表现为盆腔内巨大混合回声肿块,超声误诊为卵巢肿瘤合并子宫肌瘤。结论子宫内膜间质肉瘤的超声表现可分为四种类型:息肉生长型、肌层肿块型、肌层弥漫生长型、盆腔肿块型。在不规则出血的妇女中,尤其在绝经前期的妇女,若超声发现以上表现者,应考虑子宫内膜间质肉瘤病变的可能。     

子宫内膜息肉、黏膜下肌瘤、内膜癌超声及病理鉴别诊断

目的分析子宫内膜息肉与黏膜下肌瘤、内膜癌的超声及病理鉴别诊断。方法分析子宫内膜病变患者98例的声像图特征,并对比手术病理诊断证实超声诊断的准确度。结果子宫腔内病变患者98例中,超声诊断子宫内膜息肉48例,诊断符合率93.75%;子宫黏膜下肌瘤41例,符合率87.80%;子宫内膜癌9例,符合率88.89%。临床总符合率为90.81%。各种病变在彩色多普勒超声图像上均有特征性的表现。结论经阴道彩色多普勒超声检查对子宫腔内病变具有独特的声像图特征,典型疾病的声像图与手术标本切面之间存在规律性的对应关系,诊断准确度较高,值得临床应用和推广。     

子宫癌肉瘤的超声表现与病理特征

目的分析子宫癌肉瘤的超声声像图表现及病理组织学特点，提高对本病的认识。 方法回顾性收集2009年1月至2018年12月首都医科大学附属复兴医院收治并经病理证实的6例子宫癌肉瘤患者的临床资料，分析其超声声像图表现与病理组织学特点。 结果6例子宫癌肉瘤患者均为绝经后女性，临床表现为绝经后不同程度的阴道出血。超声表现：绝经后子宫测值增大，6例患者子宫三径之和132～248 mm，平均（199.7±36.8）mm，宫腔回声明显增厚呈息肉样，内呈不均质中高或中低回声，最大径14～81 mm，最大径平均值（47.2±21.3）mm；肿瘤部分边界清晰，可见“亮边”，形态欠规则，部分与肌层分界不清；血流评分3例4分，2例3分，1例2分，均可测及动脉血流频谱（阻力指数：0.15～0.59）。病理检查：3例为中分化子宫癌肉瘤，3例为低分化子宫癌肉瘤；镜下病理见瘤体内血管丰富；6例均伴有肌层浸润。 结论子宫癌肉瘤多表现为绝经后阴道出血伴体积较大的息肉样病变，基底部粗大的供养血管多提示肌层浸润，宫腔镜检查可获得病理诊断。     

肾上腺恶性肿瘤的超声诊断价值

目的 探讨超声对肾上腺恶性肿瘤的诊断价值.方法 回顾性研究21例肾上腺恶性肿瘤患者的临床及超声资料,观测肿瘤的位置、大小、形态、回声及彩色血流信号,肿瘤与周围血管、脏器的毗邻关系等.结果 21例肾上腺恶性肿瘤中,肿瘤直径最大17.0 cm,最小2.5 cm.其中肾上腺皮质腺癌10例,肾上腺恶性嗜铬细胞瘤4例,神经母细胞瘤瘤和神经节母细胞瘤4例,肾上腺血管源性肉瘤1例,恶性纤维组织细胞瘤1例,转移性黏液腺癌1例.不同病理性质的肾上腺恶性肿瘤的声像图表现有一定差异:肾上腺皮质癌检出时体积相对较大;肾上腺神经母细胞回声不均匀,瘤内有多发点状强回声且血供丰富.超声共检出肾上腺恶性肿瘤20例,漏诊1例.结论 各类肾上腺恶性肿瘤的声像图具有一定的特征性表现,超声是诊断肾上腺恶性肿瘤有效的影像学检查方法,在临床上具有实用价值.     

手指软组织肿块的高频超声诊断价值

目的 探讨高频彩色多普勒超声对手指部常见软组织肿块病变的诊断价值.方法 回顾性分析22例手指部软组织肿块的临床和二维及彩色多普勒超声表现,观察肿块的位置、大小、形态、回声及彩色血流信号等,并与手术和病理资料对照.结果 22例手指部软组织肿块中,腱鞘巨细胞瘤7例,腱鞘纤维瘤3例,血管球瘤5例,腱鞘囊肿7例.声像图特征有一定差异:腱鞘巨细胞瘤形态不规则,无包膜,多数瘤体内测及较丰富血流信号.腱鞘纤维瘤有完整包膜,无血流信号.血管球瘤内部呈低回声,包膜完整,血流信号丰富,Alder分级为Ⅲ级.腱鞘囊肿为囊性结构.结论 各类手指软组织肿块的声像图具有各自的特征性表现,高频超声是诊断手指软组织肿块的有效影像学方法.     

乳腺黏液癌的声像图特点及病理学基础

目的探讨乳腺黏液癌的超声特征及病理学基础.方法对44例乳腺黏液癌的超声与病理特点进行回顾性分析.结果单纯型:本组28例,超声呈低或等回声,形态规则,边界清,内部回声均质,后方回声增强.病理黏液量多,部分边缘呈膨胀性生长.本组误诊率64%(18/28).混合型:本组16例,超声呈低或等回声,形态不规则,边界不清,内部回声不均质,后方回声不增强.病理黏液量少,边缘均呈浸润表现.误诊率19%(3/16).结论单纯型黏液癌类似良性疾病,了解其声像图特点对提高诊断率有一定帮助.     

Gastrointestinal Stromal Tumors

Objective. The purpose of this series was to determine the spectrum of findings on gray scale trans‐abdominal ultrasonography (TAUS) in pathologically proven cases of primary gastrointestinal stromal tumors (GISTs) and correlate them with gross morphologic and pathologic findings. Methods. The series included 18 patients with a primary GIST tumor detected on preoperative TAUS. The ultrasonographic findings were evaluated for features such as tumor size, shape, margin, echogenicity, and presence of fluid components, and the features were compared with morphologic and pathologic findings. Results. All of the primary GISTs were hypoechoic extraluminal masses with well‐delineated margins. Eight GISTs were homogeneously solid masses, and 8 were heterogeneously solid masses that contained a large central area of lower echogenicity (n = 4) or multiple internal hypoechoic irregular spaces (n = 4) corresponding to necrosis and hemorrhage. Other tumors had a cystic appearance (n = 1) or showed a dual hyperechoichypoechoic echo structure (n = 1). Three tumors showed intratumoral gas due to fistulization into the bowel lumen, which appeared as hyperechoic foci or a linear hyperechoic area with acoustic shadowing. The heterogeneous tumors were significantly larger (P = .03) and had higher mitotic counts (P = .05). Gastrointestinal stromal tumors with high malignant potential tended to be large and showed intratumoral heterogenicity with areas of lower echogenicity. Conclusions. Gastrointestinal stromal tumors showed varied patterns on TAUS. The ultrasonographic pattern depended on the tumor size and mitotic activity. Ultrasonographic features suggesting high malignant potential were size and internal heterogenicity with the presence of intratumoral hypoechoic areas.     

Ultrasound morphology of invasive lobular breast cancer is different compared with other types of breast cancer

The aim of this study was to evaluate the ultrasound (US) morphology of invasive lobular breast carcinomas (ILC) in comparison to that of invasive tumors of other histologic differentiation (TOD). Images of 406 breast lesions were included in this retrospective study. A total of 10 US criteria (shape, orientation, echogenicity, echo pattern, calcifications, margin, margin contour, lesion boundary, surrounding tissue and posterior acoustic features) were defined and determined. Tumors were stratified into ILC (n = 69) vs. TOD (n = 337). The correlation between the sonographically and pathologically measured size of the tumors was analyzed. Irregular shape was found in 88% of ILC vs. 67% of TOD (p < 0.001). Margins were indistinct in 94% of ILC compared to 76% of TOD (p = 0.001). Posterior shadowing was observed in 84% of ILC and 58% of TOD (p = 0.001). Irregular margin contour, hyper- or isoechoic pattern and architectural distortion were more frequent in ILC. Underestimation of tumor size by US was significantly more frequent in ILC (5.4 +/- 12.2 mm) than in TOD (1.4 +/- 12.0 mm) (p = 0.015). In summary, we found that histologic differentiation significantly influences ultrasonographic appearance of breast cancer. The underestimation of tumor size of ILC might compromise the operative strategy.     

Correlation between Ultrasound Appearance of Small Breast Cancer and Axillary Lymph Node Metastasis

To study the correlation of ultrasonographic signs of small breast cancer (maximum diameter ≤2.0?cm) with axillary lymph node metastasis, pre-operative ultrasonographic images of 153 small breast malignant neoplasms in 143 breast cancer patients were analyzed according to their pathologic features. Of the small breast tumors included, 47 showed axillary lymph node metastasis. Diagnosis of all patients was obtained with radical axillary surgery or a sentinel lymph node biopsy procedure. Ultrasonographic signs included irregular shape, microlobulated contour, spiculation, microcalcification, posterior echo attenuation, blood-flow grade, perforating vessels, changes in fascia or cooper's ligament and maximum cortical thickness of lymph nodes. The relationship between ultrasonographic features and axillary lymph node metastasis was analyzed using a chi-square test for univariate distributions and logistic regression for multivariate analysis. A logistic regression model was established by taking the pathologic diagnosis of lymph node metastasis as the dependent variable and the ultrasonographic signs of each small breast cancer as independent variables. In small breast cancer, characteristics such as perforating vessels and maximum cortical thickness of lymph nodes >3.0?mm correlated well with axillary lymph node metastasis as determined by univariate analysis (χ²?=?13.945, 51.276, respectively, p?<0.05) and multivariate analysis (OR?=?48.783, 46.754, respectively, p?<0.05).     

经直肠彩超在诊断前列腺肉瘤中的价值

目的：探讨经直肠超声检查前列腺肉瘤的图像特点和内部血流变化。方法：在适当膀胱盈情况下经直肠探查前列腺,观察肿瘤大小,形态,内部回声,突入膀胱腔的程度,彩超探测肿瘤内的血流分布,速度,阻力指数。结果：7例前列腺肉瘤超声显示前列腺呈球形混合性肿块,表面不规则,呈菜花状向膀胱腔突出,肿瘤内血 供应丰富,平均血流速度为34cm/s,阻力指数（RI）平均为0．78。结论：经直肠彩超诊断前列腺肉瘤可靠性强,能显示整个肿瘤大小,内部回声,浸润程度,血流供应情况,有利于手术方法选择。     

Current concepts in the imaging of uterine sarcoma

Recent advances in genetics and pathology have improved our understanding of diagnosis and staging of uterine sarcomas. The major types of uterine sarcomas include leiomyosarcoma, low-grade endometrial stromal sarcoma, undifferentiated endometrial sarcoma, adenosarcoma and carcinosarcoma. The distinctive biological behavior and poor overall survival of uterine sarcoma create challenges in the management of these tumors. We herein present a comprehensive review of taxonomy, epidemiology, pathology, imaging findings and natural history of a wide spectrum of uterine sarcomas.