Martínez-Jiménez Santiago, Rosado-de-Christenson Melissa L, Walker Christopher M, Kunin Jeffery R, Betancourt Sonia L, Shoup Brenda L, Pettavel Paul P
From the Department of Radiology (S.M.J., M.L.R.d.C., C.M.W., J.R.K.), Department of Gynecology and Obstetrics, Division of Gynecologic Oncology (B.L.S.), and Department of Pathology (P.P.P.), Saint Luke's Hospital of Kansas City, University of Missouri in Kansas City, 4401 Wornall Rd, Kansas City, MO 64111; and Department of Radiology, MD Anderson Cancer Center, University of Texas, Houston, Tex (S.L.B.).
Radiographics. 2014 Oct;34(6):1742-54. doi: 10.1148/rg.346140052.
Gynecologic malignancies are a heterogeneous group of common neoplasms and represent the fourth most common malignancy in women. Thoracic metastases exhibit various imaging patterns and are usually associated with locally invasive primary neoplasms with intra-abdominal spread. However, thoracic involvement may also occur many months to years after initial diagnosis or as an isolated finding in patients without evidence of intra-abdominal neoplastic involvement. Thoracic metastases from endometrial carcinoma typically manifest as pulmonary nodules and lymphadenopathy. Thoracic metastases from ovarian cancer often manifest with small pleural effusions and subtle pleural nodules. Thoracic metastases to the lungs, lymph nodes, and pleura may also exhibit calcification and mimic granulomatous disease. Metastases from fallopian tube carcinomas exhibit imaging features identical to those of ovarian cancers. Most cervical cancers are of squamous histology, and while solid pulmonary metastases are more common, cavitary metastases occur with some frequency. Metastatic choriocarcinoma to the lung characteristically manifests with solid pulmonary nodules. Some pulmonary metastases from gynecologic malignancies exhibit characteristic features such as cavitation (in squamous cell cervical cancer) and the "halo" sign (in hemorrhagic metastatic choriocarcinoma) at computed tomography (CT). However, metastases from common gynecologic malignancies may be subtle and indolent and may mimic benign conditions such as intrapulmonary lymph nodes and remote granulomatous disease. Therefore, radiologists should consider the presence of locoregional disease as well as elevated tumor marker levels when interpreting imaging studies because subtle imaging findings may represent metastatic disease. Positron emission tomography/CT may be helpful in identifying early locoregional and distant tumor spread.
妇科恶性肿瘤是一组异质性常见肿瘤，是女性中第四大常见恶性肿瘤。胸部转移瘤表现出多种影像学模式，通常与具有腹腔内播散的局部浸润性原发性肿瘤相关。然而，胸部受累也可能在初次诊断后数月至数年出现，或者在没有腹腔内肿瘤受累证据的患者中作为孤立发现出现。子宫内膜癌的胸部转移通常表现为肺结节和淋巴结病。卵巢癌的胸部转移常表现为少量胸腔积液和细微的胸膜结节。肺部、淋巴结和胸膜的胸部转移也可能出现钙化，并类似肉芽肿性疾病。输卵管癌的转移表现出与卵巢癌相同的影像学特征。大多数宫颈癌为鳞状组织学类型，虽然实性肺转移更常见，但空洞性转移也时有发生。肺转移性绒毛膜癌典型表现为实性肺结节。一些妇科恶性肿瘤的肺转移在计算机断层扫描（CT）上表现出特征性表现，如空洞形成（鳞状细胞宫颈癌）和“晕”征（出血性转移性绒毛膜癌）。然而，常见妇科恶性肿瘤的转移可能很细微且进展缓慢，可能类似良性病变，如肺内淋巴结和远处肉芽肿性疾病。因此，放射科医生在解读影像学检查时应考虑局部区域疾病的存在以及肿瘤标志物水平升高，因为细微的影像学表现可能代表转移性疾病。正电子发射断层扫描/CT可能有助于识别早期局部区域和远处肿瘤播散。
