乳腺粘液腺癌MR与病理特点.pptx

Mucinous Carcinoma of the Breast:MRI Features of Pure and Mixed Forms with Histopathologic CorrelationShuichi Monzawa et al AJR March 2009,VOLUME 192 NUMBER 3乳腺粘液腺癌：纯粘液型、混合型粘液腺癌MRI特征与病理的关系杨景震 编译Fig.1A 70-year-old woman with pure mucinous carcinoma.Coronal fat-saturated T2-weighted MR image shows hyperintense mass(arrow)with oval shape and smooth margin.Fig.1B 70-year-old woman with pure mucinous carcinoma.Oblique axial early phase MR image shows mild heterogeneous enhancement predominantly at periphery of mass(arrow).Fig.1C 70-year-old woman with pure mucinous carcinoma.Coronal delayed phase MR image shows strong heterogeneous enhancement in mass(arrow).Fig.1D 70-year-old woman with pure mucinous carcinoma.Photomicrograph shows scattered clusters of tumor cells(grade 1 cellularity)in mucous lakes.(H and E,1)纯粘液腺癌ABCDFig.2 58 year-old woman with pure mucinous carcinoma.Coronal fat-saturated T2-weighted MR image shows hyperintense mass(arrow)with irregular shape and irregular margin.纯粘液腺癌Fig.3A 48-year-old woman with large pure mucinous carcinoma.Coronal fat-saturated T2-weighted MR image shows hyperintense mass(arrow)with lobulated shape and irregular margin.Dark internal septations appear as isointense lines in mass.Fig.3B 48-year-old woman with large pure mucinous carcinoma.Oblique axial early phase MR image shows mass(arrow)with strong heterogeneous enhancement and dark internal septations.Fig.3C 48-year-old woman with large pure mucinous carcinoma.Sagittal delayed phase MR image shows mass(arrow)with strong heterogeneous enhancement.Dark internal septations are less evident than in A and B.巨大纯粘液腺癌MRIFig.3D 48-year-old woman with large pure mucinous carcinoma.Photomicrograph shows marked proliferation of tumor cells with mucin collection(grade 3 cellularity).Thick fibrous septa(arrows)are evident between tumor cell clusters.(H and E,1)巨大纯粘液腺癌病理图Fig.4A 45-year-old woman with pure mucinous carcinoma.Coronal early phase MR image shows irregularly shaped mass(arrow)with strong rim enhancement.Fig.4B 45-year-old woman with pure mucinous carcinoma.Photomicrograph shows marked proliferation of tumor cells at periphery and mucous lake(asterisk)interspersed with small clusters of tumor cells in center of mass(grade 2 cellularity).(H and E,1)纯粘液腺癌Fig.5B 66-year-old woman with mixed mucinous carcinoma.Coronal early phase MR image shows mass(arrow)with strong heterogeneous enhancement.Fig.5C 66-year-old woman with mixed mucinous carcinoma.Sagittal delayed phase MR image shows mass(arrow)with strong heterogeneous enhancement.Fig.5D 66-year-old woman with mixed mucinous carcinoma.Photomicrograph shows nonmucinous components(N)intermingled diffusely with mucinous components(M)(grade 1 cellularity)throughout mass.(H and E,40)Fig.5A 66-year-old woman with mixed mucinous carcinoma.Coronal fat-saturated T2-weighted MR image shows hyperintense mass(arrow)with irregular shape and irregular margin.5A5B5C5D混合型粘液腺癌Fig.6C 37-year-old woman with mixed mucinous carcinomaPhotomicrograph shows complex tumor composed of nonmucinous components(N)at periphery and mucinous components(M)(grade 2 cellularity)in center of mass.(H and E,1)Fig.6A 37-year-old woman with mixed mucinous carcinoma.Coronal fat-saturated T2-weighted MR image shows lobulated mass(arrow)hyperintense in center and isointense at periphery.Fig.6B 37-year-old woman with mixed mucinous carcinoma.Coronal early phase MR image shows strong rim enhancement at periphery of mass(arrow).Extensive intraductal component(arrowhead)appears as focal or ductal enhancement extending from mass.混合型粘液腺癌In summary,both the pure and mixed forms of mucinous carcinoma had various shapes.Pure tumors had a smooth or irregular margin,but all mixed tumors had irregular margins.The presence of very high signal intensity on fat-saturated T2-weighted images was due to the abundant accumulation of mucus and was a common MRI feature in both forms.This finding may be a diagnostic clue suggesting the presence of mucinous carcinoma.Enhancement pattern during the early phase varied with the cellularity of pure tumors and with the distribution of nonmucinous components in mixed tumors.Hypocellular pure tumors had a typical pattern of gradual enhancement and can be diagnosed correctly with MRI.Hypercellular pure tumors had strong early enhancement and can be difficult to differentiate from mixed tumors.The presence of an area exhibiting isointensity on fat-saturated T2-weighted images and strong early enhancement imply the presence of a mixed mucinous tumor.We believe this information is useful for the diagnosis and characterization of mucinous carcinoma of the breast.研究阻25例，乳腺粘液腺癌分混合型及纯粘液腺癌2种类型。肿瘤形状：纯粘液型光滑或不规则边缘；但所有混合型均为不规则边缘。信号特征：压脂T2WI由于富含粘液蓄积而明显高信号，为两型的普遍特征。增强特点：1、早期强化，随纯粘液型肿瘤细胞的密集度、混合型中非粘液成分的分布而各异。2、细胞密集度低的纯粘液型腺癌具有典型的渐进性强化，据此MR可作出诊断；而细胞密集度高者在增强早期即有明显强化而与混合型鉴别困难。3、T2WI压脂存在等信号区域并增强早期明显强化者则提示为混合型粘液腺癌。动态扫描注意加做延时扫描请看近期本院病例女，65岁。超声检查左侧乳腺肿物粘液腺癌附：对附：对T2WIT2WI呈明显囊性特点的病灶呈明显囊性特点的病灶 影像解读与检查要点影像解读与检查要点男，24岁，左侧锁骨上窝囊性肿物4天而住院，超声检查左侧锁骨上窝囊性肿物；左侧甲状腺低回声结节。行MRI平扫，显示T2WI明显高信号，次日即行手术切除。寻找实性成分，如有即行增强检查观察邻近的淋巴结T2WI延长TE时间；须有DWI评判定性MRI优于CT病理：甲状腺乳头状癌