Mucinous Cystadenoma黏液性囊腺瘤

醫(yī)學詞匯注釋與簡要講解

Key Facts

Synonym:Benign mucinous tumor

Definition:Cystic ovarian neoplasm containing mucinous material lined by a single layer of uniform columnar cells.

Classic imaging appearance:A multilocular cyst,often very large without solid components.

Comprise 20%-25%of all benign ovarian neoplasms and 75%-85%of all ovarian mucinous tumors.

Present in 3rd to 5th decades.

Bilateral in 2%-3%of the cases.

May be very large and fill the pelvis and abdominal cavity.

mucinous黏液性

neoplasms新生物、腫瘤

multilocular多房的

Imaging Findings

General features:(1)Best imaging clue:Large multicystic mass with septations less than 3 mm.(2)Presence of solid components or papillary projections suggest borderline or malignant tumor.(3)Bilateral mucinous tumors suggest a borderline or malignant tumor.

CT findings:Multilocular cystic mass with thin cyst wall and thin septations.MR findings:(1)Cyst contents are generally low signal intensity on T1WI.(2)Locules may show higher signal intensity from concentration of mucinous components or hemorrhage on T1WI.(3)Cyst contents are very high signal intensity on T2WI.(4)Cyst walls will enhance with gadolinium.

Transvaginal ultrasound(TVS)findings:(1)Multiloculated cystic lesion.(2)Locules may show low level echoes.(3)Pulsed-wave Doppler shows generally high resistance waveforms with high resistive indices and high pulsatility indices.

septations間隔、分隔

locule囊腔，小房

transvaginal經(jīng)陰道的

Imaging Recommendations

Because mucinous cystadenomas are frequently large when they present,surgery is indicated to exclude malignancy and to prevent torsion.Extensive imaging evaluation is usually unnecessary.Ultrasonography is often sufficient to characterize tumor.CT or MR may be performed if US is equivocal or nondiagnostic to exclude findings suggestive of malignancy(solid components within mass,ascites or implants)

torsion扭轉(zhuǎn)

unilocular單房、單囊的

Differential Diagnosis

Serous cystadenoma:When mucinous cystadenomas are unilocular or have a fewloculations,they may be impossible to distinguish from serous cystadenoma.Peritoneal pseudocyst:Peritonealpseudocystsare loculationsoffluid which occur around ovary in patients with paraovarian adhesions due to endometriosis or prior surgery.

Fig 1 Pelvic MRI shows a large multicystic mass with septations less than 3 mm and well-defined wall,absence of solid components,and absence of ascites.a)axial T1WI;b)axial T2WI;c)coronal T2WI;d)axial DWI b=800;e)axial ADC map;f)enhanced coronal T1WI

Image as multilocular cystic masses:Ovary will be intact within pseudocyst;in mucinous cystadenoma the ovary is not distinguished from mass

Borderline mucinous tumor or carcinoma:(1)80%of ovarian mucinous tumors are benign.(2)Papillary projections or solid components to tumor suggest a borderline or malignant tumor.

pseudocyst假囊腫

paratovarian卵巢旁的

endometriosis子宮內(nèi)膜異位

papillary projection乳頭狀突起

Pathology

General path comments:Cyst wall is composed of a fibrous stroma.

Etiology of mucinous ovarian tumors is not known.

Occasionally mucinous tumors are associated with other ovarian tumors implying a common origin.(1)Teratomas,granulosa cell,carcinoid and Brenner tumors.(2)Appendiceal tumors may metastasize to ovary and cause a mucinous ovarian tumor identical to mucinous cystadenomas

stroma（卵巢）間質(zhì)

granulosa cell顆粒細胞

carcinoid類癌

Epidemiology

Can occur at any age but are rare in young women and children.

Most commonly present in 3rd to 5th decades.

Increased incidence in Peutz-Jeghers syndrome.

Gross pathologic:(1)Form the largest tumors known,up to 100 kg.(2)Outer surface is lobulated Internal surface is multiseptated or has cysts within cysts.(3)Cyst contents are thick mucinous material wall thickness varies from very thin to a few mm in thickness.

Microscopic features:(1)Cysts are filled with mucinous material.(2)Cysts are lined with a single layer of mucin-producing epithelium similar to endocervical epithelium or the intestinal epithelium

Peutz-Jeghers syndrome

P-J綜合征，黑斑息肉病

epithelium上皮、內(nèi)皮

Clinical Issues

Presentation:(1)Symptoms of abdominal or pelvic pressure or bloating.(2)Acute presentations due to ovarian torsion include pelvic pain and fever.(3)CA-125 levels may be mildly elevated

Treatment:(1)Excision of the mucinous cystadenoma.(2)Suspicious peritoneal areas should be biopsied to exclude peritoneal implants or microinvasion.

bloating腹脹、脹大

microinvasion微浸潤

Prognosis

Excision of benign mucinous cystadenomas is curative.There is a low incidence of bilateral tumors.

英文文字摘自 Hricak H,Reinhold C,Ascher SM,et al.Pocket radiologist：Gynecology top 100 diagnosis.Salt Lake City:Amirsys Inc,2005:89-91.

DOI：10．3969 ／j．issn．1005－8001．2020．01．016

圖片由中山大學附屬第一醫(yī)院醫(yī)學影像科提供

510080廣東廣州，中山大學附屬第一醫(yī)院醫(yī)學影像科關(guān)鍵編寫