目的 探讨卵巢硬化性间质瘤的CT、MRI表现及其病理特征.方法 选取经手术和病理证实的卵巢硬化性间质瘤9例患者临床资料,观察肿瘤的大小、形状、边缘、密度或信号及强化表现.结果 9例均为单发,肿瘤最大直径3.5～12.0 cm,平均(6.6 ±2.9)cm.肿瘤呈卵圆形5例,圆形3例,分叶状1例.CT平扫显示肿瘤界限均清楚,其中实性肿块1例,密度均匀,界限清楚,密度与子宫相近,CT值41 HU;囊实性肿块4例,内部密度不均匀,CT值16～39 HU.MRI平扫显示肿瘤均呈囊实性,其中3例肿瘤内部信号混杂,T1WI呈等信号,T2WI呈高及等信号,瘤内见"湖岛征";1例肿瘤在T1WI呈等信号,实质部分呈短T2、囊性部分呈长T2信号,内壁见结节、乳头状影,局部呈"毛刷"、"梳征"样改变.包膜在T1WI及T2WI均呈低信号.增强动脉期见肿瘤外周呈花环样、乳头状或梳齿状强化,静脉期、延迟期肿瘤实性部分渐进性、向心性强化,呈"快进慢出"为特征.病理检查9例均可见假小叶结构、印戒细胞、致密胶原纤维、疏松水肿结缔组织及丰富血管.结论 CT和MRI检查对术前诊断卵巢硬化性间质瘤具有较高临床价值.

Objective To investigate the clinical and CT features of the tuberous sclerosis complex (TSC) with multiple organ impairment.Methods Clinical presentation and CT imaging data of 10 clinically confirmed TSC patients with multiple organ impairment were retrospectively analyzed.The position, size, shape and distribution of lesions of these patients were observed .Results There were fibrous hemangioma and fibroma in skin in 8 of the 10 patients, with multiple pink and light brown translucent waxy skin rash of 0.3 -1.2 cm in diameter on the face , waist, back skin, scattered symmetrically in distribution , 3 of whom with fibroma in periungual fibromas underneath and around the nails of 0.5-3.0 cm in diameter.The sub-ependymal nodular sclerosis was found in 10 patients , and CT showed multiple calcification nodules of 0.3 -1.5 cm in diameter on both sides of the ventricles.The renal angiomyolipoma was found in 10 patients, and CT showed multiple circular hybrid density lesions of 0.3-20.0 cm in diameter in bilateral kidneys.There was pulmonary lymphangiomyomatosis in 8 patients, with CT showing scattered cystic lucency shadow in double lung , with thin walled, about 0.5-2.0 cm in diameter.The tuberous sclerosis was found in bones in 7 patients, and CT scan showed nodular opacities of 0.3-2.3 cm in diameter in thoracic , lumbar and sacral vertebrae , ribs, the parietal bone and the mandible , with clear boundary and homogeneous density involving symmetrical and irregular density in radix of the posterior arch of the vertebral body.The hepatic angiomyolipoma was found in 3 patients, and CT showed low density mass of 0.5-7.6 cm in diameter in liver , with uneven density.The heart angiomyolipoma was found in 1 patient , and CT showed streaked low density lesions with 2.5 cm ×1.2 cm in size and clear boundary in the right atrium and the right ventricular wall .Conclusions The CT performance of TSC with multiple system diseases has some certain specificity .The disease can be definitely diagnosed based on CT manifestations and clinical symptoms .

肝炎性肌纤维母细胞瘤(hepatic inflammatory myofibroblastic tumor,HIMT)是一种少见的良性肿瘤样病变,笔者遇见1例报告如下.患者 女性,39岁.因低热、右上腹隐痛、体重减轻、活动后胸闷10个月入院.查体:体温36.4℃～38.3℃,右上腹压痛及扣击痛,并扪及肿块,未见其他阳性体征.实验室检查:白细胞升高,总胆红素112.4μmol/L,直接胆红素98.1μmol/L,间接胆红素1 9.3μmol/L,谷丙转氨酶251.0U/L,谷草转氨酶156.0U/L,碱性磷酸酶554.5U/L.手术所见:肝脏质软,色泽正常,肝左外叶扪及1个大小约7.5cm×12.5cm包块,质软.

Objective To study the CT features of renal ehromophobe cell carcinoma(RCCC)in order to improve its diagnosis.Methods CT findings of 9 patients with RCCC,which were proved by operation and pathology,were analyzed retrospectively.Results These patients included 4 men and 5 women,aged 33~50 years old,with an average of 45.6 years old.Tumor maximum diameter was 2.8~20.0cm,with an average of 5.3cm.Among these tunors,5 presented with low density and 4 with isodense density,3 with uniform density,and 6 with uneven density.4 showed clear boundary,but,and 5 showed unclear boundary.3 presented with scattered of point-like or the strip or eggshell-like calcification,2 appeared cystic necrosis,and 2 exhibited bleeding.7 cases underwent enhanced CT scan.In cortical phase,lesions were exhibited mild to moderate enhancement,clear boundaries,with an average CT value of 88HU,in which density was lower than the renal cortex and medulla in 3 cases,while,the density was higher than the renal medulla,but,and lower than the renal cortex in 4 cases.In medulla period,the density of lesions was uniformly reduced,which was significantly lower than the renal cortex and medulla and shown more clearly the boundaries,with an average CT value of 85HU.Conclusion RCCC has certain characteristic CT findings,which are helpful to differentiate it from other kidney neoplasms.

患者,女,71岁.因间歇性全程无痛性肉眼血尿伴乏力、低热、体质量减轻3个月于2006年12月10 日入院.查体:体温38.2℃,腹部未触及包块.实验室检查:尿常规红细胞0.138×1012/L,白细胞0.820×1010/L;血常规血红蛋白112 g/L,血细胞沉降率50 mm/h,肾功能正常.CT检查:左肾盂见3.2 cm×2.9 cm团块影,平扫呈略低密度,CT值31 HU,密度不均匀,增强后皮质期轻度强化,CT值43 HU,密度低于肾皮质,等于肾髓质;髓质期密度低于皮质和髓质,CT值52 HU;肾盂期密度等于皮质和髓质,CT值46 HU,肿块与皮质髓质界限欠清,左肾静脉见充盈缺损。

患者,女,71岁.因间歇性全程无痛性肉眼血尿伴乏力、低热、体质量减轻3个月于2006年12月10 日入院.查体:体温38.2℃,腹部未触及包块.实验室检查:尿常规红细胞0.138×1012/L,白细胞0.820×1010/L;血常规血红蛋白112 g/L,血细胞沉降率50 mm/h,肾功能正常.CT检查:左肾盂见3.2 cm×2.9 cm团块影,平扫呈略低密度,CT值31 HU,密度不均匀,增强后皮质期轻度强化,CT值43 HU,密度低于肾皮质,等于肾髓质;髓质期密度低于皮质和髓质,CT值52 HU;肾盂期密度等于皮质和髓质,CT值46 HU,肿块与皮质髓质界限欠清,左肾静脉见充盈缺损.