子宫内膜样囊肿中发生的卵巢癌：超声表现。

Ovarian cancer arising in endometrioid cysts: ultrasound findings.

机构信息

Department of Obstetrics and Gynecology, Catholic University, Rome, Italy.

出版信息

Ultrasound Obstet Gynecol. 2011 Jul;38(1):99-106. doi: 10.1002/uog.8970. Epub 2011 Jun 16.

DOI:10.1002/uog.8970

PMID:21351179

Abstract

OBJECTIVES

To describe sonographic characteristics of malignant transformation in endometrioid cysts.

METHODS

Women with a histological diagnosis of ovarian endometrioid cysts, borderline tumors arising in endometrioid cysts and carcinoma arising in endometrioid cysts, preoperatively examined sonographically, were included in this retrospective study. Gray-scale and Doppler ultrasound characteristics of the endometrioid cysts were compared with those of the borderline tumors and primary cancers arising in endometrioid cysts. The performance of an experienced examiner in classifying the masses was also assessed.

RESULTS

Of 324 cases collected for the study, 309 (95.3%) lesions were classified as endometrioid cysts, four (1.2%) as borderline tumors arising in endometrioid cysts and 11 (3.4%) as carcinoma arising in endometrioid cysts. Women with malignant findings (borderline ovarian tumors and cancers) were older (median age 52 (range, 28-79) years) than those with benign endometrioid cysts (median age 34 (range, 18-76) years) (P<0.0001), and the prevalence of postmenopausal status was significantly higher in malignant cases. All (15/15) malignant tumors vs. 16% (50/309) of benign tumors were characterized by the presence of solid tissue (P<0.0001). The prevalence of solid tissue with positive Doppler signals was higher in malignant tumors (100%) than in benign cysts (7.8%) (P<0.0001). Papillary projections were a more frequent sonographic feature among malignant lesions (86.7%) than among benign endometrioid cysts (11.3%) (P<0.0001); power Doppler signals were detected within the projections in 92.3% and 37.1% of malignant and benign lesions, respectively. The examiner correctly diagnosed 94.8% (293/309) of benign lesions as benign and 93.3% (14/15) of malignant lesions as malignant. The risk estimation of the examiner was 'uncertain' in three (20%) and 'probably/certainly malignant' in 12 (80%) of 15 malignant cases.

CONCLUSION

Borderline tumors and carcinomas arising in endometrioid cysts show a vascularized solid component at ultrasound examination.

摘要

目的

描述子宫内膜样囊肿恶变的超声特征。

方法

本回顾性研究纳入了经组织学诊断为卵巢子宫内膜样囊肿、子宫内膜样囊肿交界性肿瘤和子宫内膜样囊肿原发性癌的女性患者。比较了子宫内膜样囊肿的灰阶和多普勒超声特征与交界性肿瘤和原发性癌的特征。还评估了有经验的检查者对肿块分类的表现。

结果

在纳入的 324 例研究病例中，309 例（95.3%）病变被归类为子宫内膜样囊肿，4 例（1.2%）为子宫内膜样囊肿交界性肿瘤，11 例（3.4%）为子宫内膜样囊肿原发性癌。有恶性发现（交界性卵巢肿瘤和癌症）的女性年龄较大（中位年龄 52 岁（范围 28-79 岁）），而良性子宫内膜样囊肿的女性年龄较小（中位年龄 34 岁（范围 18-76 岁））（P<0.0001），且恶性病例中绝经后状态的患病率明显更高。所有（15/15）恶性肿瘤与 16%（50/309）良性肿瘤均表现为实性组织（P<0.0001）。恶性肿瘤的实性组织中阳性多普勒信号的发生率（100%）高于良性囊肿（7.8%）（P<0.0001）。乳头状突起是恶性病变中更常见的超声特征（86.7%），而良性子宫内膜样囊肿中则较为少见（11.3%）（P<0.0001）；在恶性和良性病变中，分别有 92.3%和 37.1%的突起内检测到功率多普勒信号。检查者正确诊断了 94.8%（293/309）的良性病变为良性，93.3%（14/15）的恶性病变为恶性。在 15 例恶性病例中，检查者的风险评估结果为“不确定”的有 3 例（20%），“可能/肯定恶性”的有 12 例（80%）。