Tsuboyama Takahiro, Yamamoto Kazuhiro, Nakai Go, Yamada Takashi, Fujiwara Satoe, Terai Yoshito, Ohmichi Masahide, Narumi Yoshifumi
Department of Radiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan,
Abdom Imaging. 2015 Mar;40(3):459-65. doi: 10.1007/s00261-014-0323-6.
Gastric-type adenocarcinoma (GAS) of the uterine cervix is a recently defined subtype of mucinous adenocarcinoma. GAS is proposed to include minimal deviation adenocarcinoma (MDA) as a very well-differentiated form and has been suggested to arise from lobular endocervical glandular hyperplasia (LEGH). We report the magnetic resonance imaging (MRI) findings of a GAS associated with LEGH. On MRI, the LEGH component was detected as multiple cystic lesions arranged in a "cosmos pattern", while the GAS was depicted as a predominantly solid lesion containing obvious adenocarcinoma and MDA components, which appeared as mass-like and infiltrative components, respectively. The GAS exhibited tiny cysts on three-dimensional T2-weighted images, high intensity on diffusion-weighted images mostly due to T2 shine-through effect according to apparent diffusion coefficient (ADC) map, and reticular enhancement on dynamic contrast-enhanced MRI, which reflected numerous dilated glandular structures of the tumor. Low ADC was only observed at the deepest invasion front of the obvious adenocarcinoma component. Our case suggests that the MRI features of GAS vary depending on the tumor's histological components, and it is important to be aware of these imaging features when evaluating LEGH on MRI.
子宫颈胃型腺癌（GAS）是一种最近定义的黏液腺癌亚型。GAS被认为包括微小偏离腺癌（MDA）这种高分化形式，并被认为起源于小叶性宫颈腺增生（LEGH）。我们报告了一例与LEGH相关的GAS的磁共振成像（MRI）表现。在MRI上，LEGH成分表现为呈“宇宙图案”排列的多个囊性病变，而GAS则表现为以实性为主的病变，包含明显的腺癌和MDA成分，分别表现为肿块样和浸润性成分。GAS在三维T2加权图像上显示微小囊肿，在扩散加权图像上呈高信号，主要归因于根据表观扩散系数（ADC）图的T2透过效应，在动态对比增强MRI上呈网状强化，这反映了肿瘤中大量扩张的腺管结构。低ADC仅在明显腺癌成分的最深浸润前沿观察到。我们的病例表明，GAS的MRI特征因肿瘤的组织学成分而异，在MRI上评估LEGH时了解这些影像学特征很重要。
