原发性输卵管癌的MR表现

Primaryfallopiantubecarcinoma PFTC 原发性输卵管癌 Epidemiology PFTCisoneoftherarestmalignanciesofthefemalegenitaltract accountingfor0 14 1 8 ofallgynaecologicalmalignancies 妇科恶性肿瘤 occurringpredominantlyinpost menopausalwomenatameanageof55years withwomenofhighersocialclassesandeducationbeingatgreaterrisk Clinicalpresentation aetiology 病因学 hormonal 激素 reproductive 生殖的 geneticfactorsmayplayarole alongwiththepresenceofchronicinflammationofthepelvis Clinicalpresentation Characteristicsymptoms Laztko striad seeninonly15 ofpatients colicky 疝气样 abdominalorpelvicpainadnexal 附件的 massrelievedbyintermittent profuse 大量的 serosanguineousvaginaldischarge 阴道排液 Clinicalpresentation Hydropstubeprofluens 输卵管积水 seeninonly5 ofpatientsTheageofpresentationiscommonlybetween40and60years withameanageof55years Clinicalpresentation Thepre operativediagnosisofPFTCisrarelyperformed withclinicalsignsandsymptomspointingtowardsthemorefrequentlyoccurringovariancancerorpelvicinflammatorydisease ElevatedCA 125levelsareindicativeofpoorprognosis andcanbeusedduringfollow up asamarkerofdiseaserecurrence Pathologicaldiagnosis Serouscarcinoma 浆液性癌 ofthefallopiantubeisthemostcommonhistologicaltypeThesecondmostcommontypeoftumouristheendometrioidcarcinoma 子宫内膜样癌 followedbyundifferentiated clearcell mucinous andtransitionalcarinomas Pathologicaldiagnosis diagnosiscriteriaofPFTCthemaintumourarisesfromtheendosalpinx 输卵管内膜 thehistologicalpatternreproducestheepitheliumofthetubalmucosathetransitionfrombenigntomalignanttubalepitheliumisdemonstrabletheovariesorendometriumareeithernormalorcontainatumourthatissmallerthanthetumourinthetube Pathologicaldiagnosis Dissemination 播散 ofPFTCimplantationofcellsthroughouttheabdominalcavitythroughcontinuityadjacentorganstransluminalmigration 经腔转移 haematogenouslymphaticspreaddistantmetastases Treatment surgicalapproachtotalabdominalhysterectomy 子宫切除术 bilateralsalpingo oophorectomy 输卵管 卵巢切除术 infra colicomentectomy 结肠以下网膜切除术 appendicectomy peritonealwashings peritonealbiopsies Routinepelvicandpara aorticlymphadenectomy Treatment Postoperatively chemotherapyplaysanimportantroleinthemanagementofearly stagePFTCHormonaltherapiesmaybeofvalueinthefuture giventhesensitivityandresponseofthefallopiantubeepitheliumtohormonalfluctuations Prognosis Themainprognosticfactorsidentifiedforincreasedsurvivalincludestage age andresidualtumouraftersurgery seroussubtype andelevatedpre treatmentCA 125 The5 yearsurvivalrateofPFTCrangesbetween22 57 ImagingPFTC ThecharacteristicappearanceofPFTCdirectsigns relativesmall tubular shaped orsausage shaped腊肠样 manssinhomogenoussignal lowsignalintensityonT1WI isointensitytoslighthyperintensityonT2WI highsignalinDWImildtomoderateenhancementindirectsigns hydrosalpinx 输卵管积水 orintra uterinefluid AnatomyofthefallopiantubesonMRI ThenormalfallopiantubesareusuallynotvisualizedonpelvicMRI Inthepresenceofintraperitonealfluid theymaybeseenaspairedthinstructures extendingfromtheovariestotheuterinecornua inthesuperioredgeofthebroadligament AnatomyofthefallopiantubesonMRI 10 12cmdividedintofourportionsintramural interstitialonthemedialendtheisthmustheampullatheinfundibulumatthelateralfimbriatedend AnatomyofthefallopiantubesonMRI Tubular sausage shapedmass A52 year oldwomanwithaprimaryfallopiantubecarcinomaontheleftside SagittalturboSET2WIwithfatsaturation a showsasausage likesolidmass arrow withslightlyhyperintensesignalandmoderateenhancementoncontrast enhancedFLASH2DT1WIwithfatsaturation b A62 year oldwomanwithaprimaryfallopiantubecarcinomaontheleftside AxialSET1WI a turboSET2WIwithfatsaturation b andcontrast enhancedFLASH2DT1WIwithfatsaturation c An81 year oldwomanwithaprimaryfallopiantubecarcinomaontherightside MRIfordifferentiatingprimaryfallopiantubecarcinomafromepithelialovariancancer SignificantdifferencesbetweenPFT