上海口腔医学

上海口腔医学 ›› 2023, Vol. 32 ›› Issue (3): 255-260.doi: 10.19439/j.sjos.2023.03.007

• 论著 • 上一篇    下一篇

43例小唾液腺癌在多形性腺瘤中的影像学表现

朱文静1, 余强1, 陶晓峰1, 王韶颖1,*, 田涛1,*, 张春叶2   

  1. 1.上海交通大学医学院附属第九人民医院 放射科,2.病理科,上海 200011
  • 收稿日期:2021-11-15 修回日期:2022-08-16 出版日期:2023-06-25 发布日期:2023-06-28
  • 通讯作者: 王韶颖,E-mail: syw330@sina.com;田涛,E-mail: 18049873220@163.com。*共同通信作者
  • 作者简介:朱文静（1983-）,女,硕士,主治医师,E-mail：amanda_1983_328@163.com
  • 基金资助:
    国家自然科学基金（91859202,81771901）

Imaging findings of carcinoma ex pleomorphic adenoma in minor salivary glands

ZHU Wen-Jing1, YU Qiang1, TAO Xiao-feng1, WANG Shao-ying1, TIAN Tao1, ZHANG Chun-ye2   

  1. 1. Department of Radiology, 2. Department of Pathology, Shanghai Ninth People’s Hospital School of Medicine Shanghai Jiao Tong University. Shanghai 200011, China
  • Received:2021-11-15 Revised:2022-08-16 Online:2023-06-25 Published:2023-06-28

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摘要： 目的：总结小唾液腺癌在多形性腺瘤中的CT和MRI特征,分析其与病理分型的相关性。方法：收集经手术后病理检查证实的小唾液腺癌在多形性腺瘤中患者43例,分析CT和MRI表现,并将其与病理分型相关联。采用SPSS 25.0软件包中的Fisher确切概率法分析Ⅰ/Ⅱ型和Ⅲ型之间肿瘤形态、边界、内部结构、骨质侵犯和颈淋巴结转移等与病理分型的相关性。结果：83.7%（36/43）的肿瘤边缘呈分叶状;81.4%（35/43）内部出现囊变或坏死,呈现不均匀强化;37.2%（16/43）可见粗钙化或混合钙化灶;25.6%（11/43）出现邻近骨质压迫性吸收。75%（12/16）的Ⅰ/Ⅱ型肿瘤形态规则（圆形或卵圆形）,77.8%（21/27）的Ⅲ型肿瘤形态不规则。93.8%（15/16）的Ⅰ/Ⅱ型肿瘤边界清楚,66.7%（18/27）的Ⅲ型肿瘤边界模糊。59.3%（16/27）的Ⅲ型肿瘤出现溶骨性骨质吸收。Ⅰ/Ⅱ型肿瘤平均最大径显著小于Ⅲ型（P<0.05）。Fisher确切概率法分析显示,肿瘤形态、边界、溶骨性骨质吸收3种影像特征与病理分型相关（P<0.001）。结论：大部分小唾液腺癌在多形性腺瘤中的CT和MRI表现以边缘分叶状,不均匀强化为共同特征。Ⅰ/Ⅱ型肿瘤形态多呈圆形或卵圆形、边界清楚,罕见溶骨性骨质破坏;Ⅲ型肿瘤多数形态不规则、边界模糊且易出现溶骨性骨质破坏。将形态、边界和溶骨3种特征相结合,更有助于鉴别Ⅰ/Ⅱ型和Ⅲ型肿瘤。

关键词: 癌在多形性腺瘤中, 小唾液腺, CT, MRI

Abstract: PURPOSE: To summarize the CT and MR imaging features of carcinoma ex pleomorphic adenoma(Ca-ex-PA) in minor salivary gland, and analyze the correlation between various features and pathological classification. METHODS: Forty-three patients with Ca-ex-PA in minor salivary gland were collected. The CT and MRI findings were retrospectively analyzed and correlated with their pathological types. Fisher's exact test was used to analyze the correlation between various imaging features (tumor morphology, boundary, internal structure, bone invasion, cervical lymph node metastasis) and pathological types with SPSS 25.0 software package. RESULTS: Among the 43 patients with Ca-ex-PA, 83.7%(36/43) of the tumors were lobulated; 81.4%(35/43) showed cystic degeneration or necrosis, with heterogeneous enhancement. Coarse calcification or mixed calcification was found in 37.2%(16/43), 25.6%(11/43) had compressive absorption of adjacent bone. 75%(12/16) of type Ⅰ/Ⅱ tumors had regular morphology (round or oval), and 77.8%(21/27) of type Ⅲ tumors had irregular morphology, 93.8%(15/16) of type Ⅰ/Ⅱ tumors had well-defined margin and 66.7%(18/27) of type Ⅲ tumors had ill-defined margin. Osteolytic bone resorption occurred in 59.3%(16/27) of type Ⅲ tumors. The average maximum diameter of type Ⅰ/Ⅱ tumors was significantly shorter than that of type Ⅲ(P<0.05). Fisher's exact test showed the characteristics of tumor morphology, boundary and osteolytic bone resorption were related to pathological grouping(P<0.001). CONCLUSIONS: Most Ca-ex-PA in minor salivary glands is characterized by lobular and heterogeneous enhanced neoplasm on CT and MR imaging. A round or oval tumor with well-defined margin usually correlates with typeⅠ and Ⅱ, contrarily, an irregular mass with ill-defined margin and osteolytic bone destruction usually correlates with type Ⅲ. Combining the three characteristics of morphology, boundary and osteolysis is more helpful to distinguish type Ⅰ/Ⅱ and type Ⅲ tumors.

Key words: Carcinoma ex pleomorphic adenoma, Minor salivary glands, CT, MRI

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