标题：卵巢支持-间质细胞肿瘤患者的CT影像特征及病理学特点

      作者：孙怡咪 1，刘为 2，李雷 1    1.西安市第九医院CT磁共振科，陕西 西安 710054；2.西安市第一医院影像科，陕西 西安 710002

      卷次： 2022年33卷20期

      【摘要】 目的 探究卵巢支持-间质细胞肿瘤(SLCT)患者的CT影像特征，并分析其病理学特点。方法 回顾性分析2015年6月至2021年6月西安市第九医院经手术病理证实的12例SLCT患者的一般临床、病理及影像学资料，分析患者的CT影像特征和临床病理学特点。结果 12例SLCT患者，4例表现为绝经后出血、腹胀，3例存在附件包块，2例出现男性化症状，3例表现为月经紊乱。所有患者血清睾酮水平均升高，4例患者雌二醇水平升高，FIGO分期均为Ⅰa期。CT平扫显示，所有患者均为单发肿瘤，包括左侧7例，右侧5例；肿瘤横断面大小为4.2 cm×3.7 cm~12.5 cm×11.3 cm；9例呈囊实性肿块，3例呈实性肿块；肿块边界清晰，密度不均匀，囊壁可见钙化。增强扫描显示，囊壁、肿瘤实性成分呈进行性、明显强化或中度强化，囊内无强化，可见同侧卵巢静脉明显迂曲、增粗。病理检查结果显示，肿瘤呈圆形或卵圆形，表面存在纤维包膜，切面呈黄白色，共诊断高分化2例，中分化4例，低分化4例。免疫组化检测结果显示，Inhibin-α (+) 12例，Vimentin (+) 10例，Calretinin (+) 4例，Ki67 (+) 5例，CK7 (+) 2例。结论 SLCT患者的CT表现存在一定特征，多表现为单侧囊实性或实性肿块，肿块边界清晰，密度不均匀，囊壁可见钙化，实性成分呈进行性中度或明显强化，结合临床病理特征及免疫组化结果可提高临床诊断准确率。
      【关键词】 卵巢肿瘤；卵巢支持-间质细胞肿瘤；X线计算机；体层摄影术；临床病理
      【中图分类号】 R737.31 【文献标识码】 A 【文章编号】 1003—6350（2022）20—2668—04

CT imaging characteristics and pathological characteristics of patients with Sertoli-Leydig cell tumors.
SUNYi-mi 1, LIU Wei 2, LI Lei 1. 1.Department of CT Magnetic Resonance, Xi'an Ninth Hospital, Xi'an 710054, Shaanxi, CHINA;2. Department of Imaging, Xi'an First Hospital, Xi'an 710002, Shaanxi, CHINA
【Abstract】 Objective To explore CT imaging characteristics of patients with Sertoli-Leydig cell tumors(SLCT), and to analyze their pathological characteristics.Methods The generally clinical, pathological and imaging da-ta of 12 patients with SLCT confirmed by surgical pathology in Xi’an Ninth Hospital between June 2015 and June 2021were retrospectively analyzed. CT imaging characteristics and clinicopathological characteristics of the patients were an-alyzed. Results Among the 12 SLCT patients, there were 4 cases with postmenopausal bleeding and abdominal disten-sion, 3 cases with adnexal tumors, 2 cases with virilizationsymptoms, and 3 cases with menstrual disorders. The level ofserum testosterone in all patients was increased. There were 4 patients with increased estradiol, and FIGO staging wasstage Ⅰa. CT plain scan showed that all patients were accompanied with single tumor, including 7 cases on the left sideand 5 cases on the right side. Cross-sectional size of the tumor was 4.2 cm×3.7 cm to 12.5 cm×11.3 cm. There were 9 caseswith cystic solid masses and 3 cases with solid mass, with clear boundaries, uneven density and calcification in cystwalls. The enhanced scan showed that cyst walls and solid components of tumors showed progressive, significant ormoderate enhancement. There was no enhancement inside the cysts. The ipsilateral ovarian veins were significantly tortu-ous and thickened. Pathological examination results showed that the tumors were round or oval, with fibrous capsules ontheir surface. The section plane was yellow-white. There were 2 cases with high differentiation, 4 cases with moderatedifferentiation and 4 cases with low differentiation. The results of immunohistochemistry showed that there were 12 cas-es with Inhibin-α (+), 10 cases with Vimentin (+), 4 cases with Calretinin (+), 5 cases with Ki67 (+), and 2 cases withCK7 (+). Conclusion There are certain characteristics of CT findings in SLCT patients, most are characterized by uni-lateral cystic solid or solid masses with clear boundaries, uneven density and calcification in cyst walls. The solid compo-nents show progressive, moderate or significant enhancement. The combination of CT imaging characteristics with clini-cal pathological characteristics and immunohistochemistry results can improve the accuracy rate of clinical diagnosis.
      【Key words】 Ovarian tumor; Sertoli-Leydig cell tumor; X-ray computed; Tomography; Clinical pathology