原发性输卵管癌的MR表现

Primary fallopian tube carcinoma（PFTC）原发性输卵管癌,苏欢欢2015-08,Epidemiology,PFTC is one of the rarest malignancies of the female genital tract, accounting for 0.14-1.8% of all gynaecological malignancies（妇科恶性肿瘤）.occurring predominantly in post-menopausal women at a mean age of 55 years, with women of higher social classes and education being at greater risk.,Clinical presentation,aetiology（病因学）hormonal（激素）, reproductive（生殖的）, genetic factors may play a role, along with the presence of chronic inflammation of the pelvis.,Clinical presentation,Characteristic symptoms (Laztkos triad, seen in only 15% of patients)colicky(疝气样) abdominal or pelvic painadnexal(附件的) massrelieved by intermittent, profuse(大量的), serosanguineous vaginal discharge(阴道排液),Clinical presentation,Hydrops tube profluens(输卵管积水)：seen in only 5% of patientsThe age of presentation is commonly between 40 and 60 years, with a mean age of 55 years.,Clinical presentation,The pre-operative diagnosis of PFTC is rarely performed, with clinical signs and symptoms pointing towards the more frequently occurring ovarian cancer or pelvic inflammatory disease. Elevated CA-125 levels are indicative of poor prognosis, and can be used during follow-up, as a marker of disease recurrence,Pathological diagnosis,Serous carcinoma(浆液性癌) of the fallopian tube is the most common histological typeThe second most common type of tumour is the endometrioid carcinoma(子宫内膜样癌), followed by undifferentiated, clear cell, mucinous, and transitional carinomas.,Pathological diagnosis,diagnosis criteria of PFTCthe main tumour arises from the endosalpinx(输卵管内膜)the histological pattern reproduces the epithelium of the tubal mucosathe transition from benign to malignant tubal epithelium is demonstrablethe ovaries or endometrium are either normal or contain a tumour that is smaller than the tumour in the tube,Pathological diagnosis,Dissemination(播散) of PFTCimplantation of cells throughout the abdominal cavitythrough continuity adjacent organstransluminal migration（经腔转移）haematogenouslymphatic spreaddistant metastases,Treatment,surgical approachtotal abdominal hysterectomy(子宫切除术)bilateral salpingo-oophorectomy（输卵管-卵巢切除术）infra-colic omentectomy（结肠以下网膜切除术）, appendicectomy, peritoneal washings, peritoneal biopsies.Routine pelvic and para-aortic lymphadenectomy,Treatment,Postoperatively, chemotherapy plays an important role in the management of early-stage PFTCHormonal therapies may be of value in the future, given the sensitivity and response of the fallopian tube epithelium to hormonal fluctuations,Prognosis,The main prognostic factors identified for increased survival include stage, age, and residual tumour after surgery, serous subtype, and elevated pre-treatment CA-125.The 5-year survival rate of PFTC ranges between 22-57%.,Imaging PFTC,The characteristic appearance of PFTCdirect signs: relative small, tubular-shaped (or sausage-shaped腊肠样) manssinhomogenous signal, low signal intensity on T1WI, isointensity to slight hyperintensity on T2WI, high signal in DWImild to moderate enhancementindirect signs: hydrosalpinx（输卵管积水） or intra-uterine fluid,Anatomy of the fallopian tubes on MRI,The normal fallopian tubes are usually not visualized on pelvic MRI.In the presence of intraperitoneal fluid, they may be seen as paired thin structures, extending from the ovaries to the uterine cornua, in the superior edge of the broad ligament.,Anatomy of the fallopian tubes on MRI,10-12cmdivided into four portionsintramural/interstitial on the medial endthe isthmusthe ampullathe infundibulum at the lateral fimbriated end,Anatomy of the fallopian tubes on MRI,Tubular/sausage-shaped mass,A 52-year-old woman with a primary fallopian tube carcinoma on the left side. Sagittal turbo SE T2WI with fat saturation (a) shows a sausage-like solid mass (arrow) with slightly hyperintense signal and moderate enhancement on contrast-enhanced FLASH 2D T1WI with fat saturation (b).,A 62-year-old woman with a primary fallopian tube carcinoma on the left side. Axial SE T1WI (a), turbo SE T2WI with fat saturation (b), and contrast-enhanced FLASH 2D T1WI with fat saturation (c),An 81-year-old woman with a primary fallopian tube carcinoma on the right side.,MRI for differentiating primary fallopian tube carcinoma from epithelial ovarian cancer,Significant differences between PFTC