睾丸恶性卵黄囊瘤伴未成熟畸胎瘤超声表现1例

2020-06-26 卞东林 王学梅 中国临床医学影像杂志

病例男,18岁,以“发现右侧睾丸肿大伴疼痛1周余”为主诉入我院。患者无血精、血尿,无尿频、尿急、尿痛,无排尿困难;无寒战发热,无低热、乏力盗汗;无恶心呕吐,无头晕头迷,无心悸气

病例男,18岁,以“发现右侧睾丸肿大伴疼痛1周余”为主诉入我院。患者无血精、血尿,无尿频、尿急、尿痛,无排尿困难;无寒战发热,无低热、乏力盗汗;无恶心呕吐,无头晕头迷,无心悸气短。

体格检查:双侧精索静脉无曲张;阴茎发育正常;阴囊壁未见红肿及皮肤溃疡;右睾丸可触及,但较对侧增大,质地硬,沉重感明显,表面光滑,未触及明显异常结节,无明显压痛,透光试验阴性;双侧附睾及输精管未触及明显异常结节。

超声检查:右睾丸上2/3可见囊实混合回声团块(图1),大小约4.16 cm×3.49 cm,以实性为主,边界清晰,形态规则,实质与正常睾丸实质回声相近,回声不均,囊性回声呈小片状,边缘可见少许点状血流(图2);左睾丸及附睾大小形态正常,实质回声细小均匀,血流未见明显异常。增强CT检查:右睾丸增大,内见直径约4.44cm模糊稍低密度影,内密度不均,可见絮状等密度影,平扫CT值约27HU,增强后动脉期及门脉期强化不明显,延迟期CT值约36HU,边缘见线状强化影(图3)。


图1~3睾丸恶性混合性生殖细胞瘤。图1:超声二维声像图表现为囊实混合性、边界清晰的肿块。图2:超声血流声像图表现为边缘少许点状血流。图3:增强CT图像表现为边缘强化影。

实验室检查:甲胎蛋白(AFP):193.80ng/mL(参考值0.00~7.00ng/mL);血清人绒毛膜促性腺激素(HCG):11.72mIU/mL(参考值0.00~3.00mIU/mL)。术后病理镜下:肿瘤组织结构多样,部分呈腺样排列,伴微囊形成,细胞核大深染,部分呈实性分布,胞浆透明,界限清晰,周围见不成熟软骨成分;诊断意见:睾丸恶性混合性生殖细胞瘤(卵黄囊瘤伴未成熟畸胎瘤,局部见原位精原细胞瘤成分)。

讨论

睾丸生殖细胞瘤是睾丸最好发的恶性肿瘤,包括精原细胞瘤和非精原细胞瘤,前者常见,后者少见且病理成分复杂,大体包括卵黄囊瘤(又名内胚窦瘤)、畸胎瘤、胚胎癌、绒毛膜上皮癌等。非精原细胞瘤可以含一种或多种成分。本病例含多种成分,故称为混合性生殖细胞瘤。

临床上混合性生殖细胞瘤相对少见,而本例患者同时存在卵黄囊瘤、未成熟畸胎瘤,并且局部可见原位精原细胞瘤成分,此病例极为罕见。本例超声表现为囊实混合性肿物,呈稍高回声,囊性成分相对较少,血流呈边缘型。阴囊超声检查已广泛应用,是目前临床最常用的阴囊疾病的诊断方法。超声对睾丸病变具有多方面的诊断优势,可以在极大程度上满足临床的要求,如大小、形态、边界、囊实性、血供、毗邻关系并且简单易行。超声在微血管显示方面的缺陷,可以通过超声造影来弥补。
总之,超声对睾丸病变的诊断具有较高的敏感性。

原始出处:

卞东林,王学梅.睾丸恶性卵黄囊瘤伴未成熟畸胎瘤超声表现1例[J].中国临床医学影像杂志,2019(03):224.

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    2020-07-14 wxl882001

    了解一下

    0

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    2020-06-28 zhangph
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至今为止,NSGCT细胞类型的重要性尚不确定。最近,研究人员评估了畸胎瘤对NSGCT患者生存的长期影响。

原发性卵巢恶性黑色素瘤合并成熟性畸胎瘤一例

患者 女,25岁。主因腹胀20d,于2015年12月10日入 本院。患者20d前无明显诱因自觉下腹胀,无明显腹痛,伴 食欲不佳,自以为胃部不适,嚼服健胃消食片1d,下腹胀未 见缓解,就诊于秦皇岛当地医院,行腹部B超检查示:盆腹腔 积液,建议进一步妇科就诊,遂至秦皇岛市妇幼保健院,妇科B超提示子宫右前方实性占位,性质待查,部分腹膜及系膜增 厚,盆腹腔大量腹水,遂住院治疗,给予腹水引流缓解腹胀, 并静

突发头痛伴恶心、呕吐1天.....

突发头痛伴恶心、呕吐1天.....

左耳部成熟畸胎瘤伴感染1例

患儿,女,1岁;因“左耳流脓伴耳周肿胀3天”入院。3天前患儿左耳流黄色脓液,伴发热,最高体温39°,耳周肿胀,抗感染治疗后耳部流脓减少。查体:左耳垂周围皮肤肿胀,可触及一鸡蛋大小包块,质地硬,有触痛,外耳无畸形,左耳道可见较多黄色黏液性分泌物,骨膜未见膨隆,右耳未见异常。实验室检查:白细胞计数11.83×109/L;中性粒细胞比率82.10%。