Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India.
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Br J Radiol. 2020 Jul;93(1111):20200255. doi: 10.1259/bjr.20200255. Epub 2020 May 21.
To evaluate the imaging characteristics of aggressive angiomyxoma (AA) and identify features which would help to differentiate it from similar appearing lesions.
A retrospective review of departmental records was done and cases where AA was suspected on CT or MRI were included. With histopathology as gold-standard, the cases were grouped into AA or mimics and differentiating features were identified on USG, CT and MRI. Fischer's exact test was applied for the statistical significance of the differentiating features.
18 patients were identified of which 2 were excluded for lack of histopathology records. 10 were AA and 6 mimics which included 2 fibromatoses, 2 neurogenic tumors, and 1 each of germ cell tumor and inflammatory myofibroblastic tumor. On MRI, all AA showed T2 hyperintensity and intense contrast enhancement with characteristic laminated pattern in 7/9 cases. Diffusion restriction was seen in 2/3 cases, cystic component in 4/10 and hemorrhage in 1/10 cases. Pelvic fibromatosis was the closest imaging differential showing laminated pattern in one of the cases.
Large pelvic mass with abdominal/perineal extension in reproductive age female patient should lead to suspicion of AA. Laminated pattern on weighted images and intense homogeneous contrast enhancement further add to the diagnostic confidence.
This study for the first time describes radiological mimics of AA. Large cystic component, diffusion restriction, hemorrhage and organ infiltration have not been previously described in AA.
评估侵袭性血管黏液瘤（AA）的影像学特征，确定有助于将其与具有相似表现的病变区分开来的特征。
回顾性分析科室病历，纳入 CT 或 MRI 怀疑 AA 的病例。以组织病理学为金标准，将病例分为 AA 或类似物，并在 USG、CT 和 MRI 上确定鉴别特征。应用 Fisher 确切检验评估鉴别特征的统计学意义。
共发现 18 例患者，其中 2 例因缺乏组织病理学记录而被排除。10 例为 AA，6 例为类似物，包括 2 例纤维瘤病、2 例神经源性肿瘤、1 例生殖细胞肿瘤和 1 例炎症性肌纤维母细胞瘤。在 MRI 上，所有 AA 均表现为 T2 高信号，9 例中有 7 例表现出特征性的分层强化模式。2 例可见弥散受限，4 例可见囊性成分，1 例可见出血。盆腔纤维瘤病是最接近的影像学鉴别诊断，其中 1 例表现出分层模式。
在生殖年龄女性患者中，出现盆腔巨大肿块并向腹部/会阴延伸时，应怀疑为 AA。T2 加权图像上的分层模式和均匀强化进一步增强了诊断信心。
本研究首次描述了 AA 的影像学类似物。大的囊性成分、弥散受限、出血和器官浸润以前并未在 AA 中描述过。
