原发性输卵管癌的MR表现

Primaryfallopiantubecarcinoma（PFTC）原发性输卵管癌苏欢欢2015-08EpidemiologyPFTCisoneoftherarestmalignanciesofthefemalegenitaltract,accountingfor0.14-1.8%ofallgynaecologicalmalignancies（妇科恶性肿瘤）.occurringpredominantlyinpost-menopausalwomenatameanageof55years,withwomenofhighersocialclassesandeducationbeingatgreaterrisk.Clinicalpresentationaetiology（病因学）hormonal（激素）,reproductive（生殖的）,geneticfactorsmayplayarole,alongwiththepresenceofchronicinflammationofthepelvis.ClinicalpresentationCharacteristicsymptoms(Laztko'striad,seeninonly15%ofpatients)colicky(疝气样)abdominalorpelvicpainadnexal(附件的)massrelievedbyintermittent,profuse(大量的),serosanguineousvaginaldischarge(阴道排液)ClinicalpresentationHydropstubeprofluens(输卵管积水)：seeninonly5%ofpatientsTheageofpresentationiscommonlybetween40and60years,withameanageof55years.PathologicaldiagnosisSerouscarcinoma(浆液性癌)ofthefallopiantubeisthemostcommonhistologicaltypeThesecondmostcommontypeoftumouristheendometrioidcarcinoma(子宫内膜样癌),followedbyundifferentiated,clearcell,mucinous,andtransitionalcarinomas.PathologicaldiagnosisdiagnosiscriteriaofPFTCthemaintumourarisesfromtheendosalpinx(输卵管内膜)thehistologicalpatternreproducestheepitheliumofthetubalmucosathetransitionfrombenigntomalignanttubalepitheliumisdemonstrabletheovariesorendometriumareeithernormalorcontainatumourthatissmallerthanthetumourinthetubePathologicaldiagnosisDissemination(播散)ofPFTCimplantationofcellsthroughouttheabdominalcavitythroughcontinuityadjacentorganstransluminalmigration（经腔转移）haematogenouslymphaticspreaddistantmetastasesTreatmentsurgicalapproachtotalabdominalhysterectomy(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-aorticlymphadenectomyTreatmentPostoperatively,chemotherapyplaysanimportantroleinthemanagementofearly-stagePFTCHormonaltherapiesmaybeofvalueinthefuture,giventhesensitivityandresponseofthefallopiantubeepitheliumtohormonalfluctuationsPrognosisThemainprognosticfactorsidentifiedforincreasedsurvivalincludestage,age,andresidualtumouraftersurgery,seroussubtype,andelevatedpre-treatmentCA-125.The5-yearsurvivalrateofPFTCrangesbetween22-57%.ImagingPFTCThecharacteristicappearanceofPFTCdirectsigns:relativesmall,tubular-shaped(orsausage-shaped腊肠样)manssinhomogenoussignal,lowsignalintensityonT1WI,isointensitytoslighthyperintensityonT2WI,highsignalinDWImildtomoderateenhancementindirectsigns:hydrosalpinx（输卵管积水）orintra-uterinefluidAnatomyofthefallopiantubesonMRIThenormalfallopiantubesareusuallynotvisualizedonpelvicMRI.Inthepresenceofintraperitonealfluid,theymaybeseenaspairedthinstructures,extendingfromtheovariestotheuterinecornua,inthesuperioredgeofthebroadligament.AnatomyofthefallopiantubesonMRI10-12cmdividedintofourportionsintramural/interstitialonthemedialendtheisthmustheampullatheinfundibulumatthelateralfimbriatedendAnatomyofthefallopiantubesonMRITubular/sausage-shapedmassA52-year-oldwomanwithaprimaryfallopiantubecarcinomaontheleftside.SagittalturboSET2WIwithfatsaturation(a)showsasausage-likesolidmass(arrow)withslightlyhyperintensesignalandmoderateenhancementoncontrast-enhancedFLASH2DT1WIwithfatsaturation(b).A62-year-oldwomanwithaprimaryfallopiantubecarcinomaontheleftside.AxialSET1WI(a),turboSET2WIwithfatsaturation(b),andcontrast-enhancedFLASH2DT1WIwithfatsaturation(c)An81-year-oldwomanwithaprimaryfallopiantubecarcinomaontherightside.MRIfordifferentiatingprimaryfallopiantubecarcinomafromepithelialovariancancerSignificantdifferencesbetweenPFTCandEOCwerefo