目的：探讨结直肠黏液腺癌的CT表现。方法：回顾性分析经病理证实为结直肠黏液腺癌的109例患者的CT资料，包括肿瘤的位置和长度、肠壁厚度及增厚的形式、增强形式、病灶内低密度区情况、肠周侵犯情况、有无结肠梗阻或其他器官转移、有无钙化。结果：109例结直肠黏液腺癌中，26例位于升结肠，10例位于横结肠，7例位于降结肠，22例位于乙状结肠，44例位于直肠。肿瘤长度1.9～17.6 cm（平均6.1 cm）；病变肠壁厚度0.6～5.6 cm（平均2.1 cm）。89例为肠壁环状增厚，11例为肠壁局部增厚，9例为肠壁息肉样肿块。CT平扫病灶均呈稍低密度影，其中20例病灶内见钙化；增强后67例呈轻度强化，30例呈中度强化，14例呈明显强化；所有病灶内增强后均有不同程度低密度区域，49例表现为病灶内大量低密度影，39例表现为中量低密度影，21例表现为少量低密度影。肠周间隙轻度浸润的有51例，中度39例，重度19例。57例伴有肠周淋巴结转移，25例有腹膜种植转移，7例有肝脏转移，1例同时有肝脏和卵巢转移，1例有肺转移。结论：结直肠黏液腺癌的CT表现具有一定特征性，多表现为较大范围的肠壁环形增厚，均有低密度区并部分可见钙化灶，并常伴有淋巴结和腹膜种植转移。
Abstract
Objective: To explore the CT findings of colorectal mucinous adenocarcinoma. Methods: The CT scans of 109 cases of colorectal mucinous adenocarcinoma confirmed by surgery and pathology were reviewed retrospectively． Results: The tumors were located in the rectum in 44 cases, the sigmoid colon in 22 cases, the ascending colon in 26 cases, the transverse colon in 10 cases, and the descending colon in 7 cases. The tumor length ranged from 1.9 to 17.6 cm(mean 6.1 cm) with mean thickness of 2.1 cm(ranged from 0.6 to 5.6 cm). CT showed annular bowel wall thickening in 89 cases, regional bowel wall thickening in 11 cases, polypoid mass-forming in 9 cases. Nonenhanced CT scan showed hypodense lesions, calcification in 20 cases and contrast-enhanced CT showed heterogeneous enhancement patterns. Contrast-enhanced CT also showed different degree of low density region in the lesions, massive low-density region in 49 cases, moderate low-density region in 39 cases, and little low-density region in 21 cases. Perirectal or pericolic infiltrations were moderate to severe. In the tumor spread patterns, lymph nodes metastasis was noted in 57 cases, peritoneal carcinomatosis in 25 cases, liver metastasis in 7 cases, liver and ovary metastasis in 1 case, and lung metastasis in 1 case. Conclusion: There were some features of primary colorectal mucinous adenocarcinoma in CT. It usually showed annular bowel wall thickening with low-density region, partly with calcification, lymph nodes and peritoneal carcinomatosis.
关键词
结直肠肿瘤 /
腺癌 /
粘液 /
体层摄影术 /
X线计算机
Key words
Colorectal neoplasms /
Adenocarcinoma, mucinous /
Tomography, X-ray computed
中图分类号：
Ｒ735.35
Ｒ735.37
Ｒ730.261
Ｒ814.42
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参考文献
[1]Symonds DA, Vickery AL. Mucinous carcinoma of the colon and rectum[J]. Cancer, 1976, 37(4): 1891-1900.
[2]Nozoe T, Anai H, Nasu S, et al. Clinicopathological characteristics of mucinous carcinoma of the colon and rectum[J]. J Surg Oncol, 2000, 75(2): 103-107.
[3]Corvino A, Corvino F, Radice L. Synchronous mucinous colonic adenocarcinoma and multiple small intestinal adenocarcinomas: report of a case and review of literature[J]. Clin Imaging, 2015, 39(3): 538-542.
[4]黄斯韵，孙灿辉，李雪华，等. CT联合正电子发射计算机断层成像术对结直肠黏液腺癌与非黏液腺癌的鉴别诊断[J]. 中华胃肠外科杂志，2014，17（3）：230-234.
[5]Hanski C. Is mucinous carcinoma of the colorectum a distinct genetic entity?[J]. Br J Can, 1995, 72(6): 1350.
[6]Nissan A, Guillem JG, Paty PB, et al. Signet-ring cell carcinoma of the colon and rectum[J]. Dis Colon Rect, 1999, 42(9): 1176-1180.
[7]Parham D. Colloid carcinoma[J]. Ann Surg, 1923, 77(1): 90-105.
[8]中华人民共和国卫生和计划生育委员会医政医管局，中华医学会肿瘤学会分会. 中国结直肠癌诊疗规范（2015版）[J]. 中华普通外科学文献：电子版，2015，9（6）：506-523.
[9]Gao P, Song Y, Xu Y, et al. Does the prognosis of colorectal mucinous carcinoma depend upon the primary tumor site? Results from two independent data bases[J]. Histopathology, 2013, 63(5): 603-615.
[10]万德森. 结直肠癌流行趋势及其对策[J]. 癌症，2009，28（9）：897-902.
[11]王光辉，谷金宇，崔龙. 大肠黏液腺癌临床病理特征的分析[J]. 中华普外科手术学杂志：电子版，2012，6（3）：14-16.
[12]Ey K, Hk H, Ay K, et al. Ct differentiation of mucinous and nonmucinous colorectal carcinoma[J]. Am J Roentgenol, 2007, 188(3): 785-790.
[13]李振辉，董兴祥，高德培，等. 结直肠原发印戒细胞癌与腺癌的CT表现比较[J]. 中国医学影像学杂志，2015，23（11）：834-838.
[14]王锡明，武乐斌，张云亭，等. 多层螺旋CT动态增强扫描在结肠淋巴瘤诊断中的应用[J]. 中华肿瘤杂志，2006，28（11）：876-878.
[15]李振辉，张治平，王关顺，等. 原发性肛管直肠恶性黑色素瘤的CT和MRI表现[J]. 放射学实践，2014，29（8）：957-960.
基金
本课题受云南省科技厅-昆明医科大学应用基础研究联合专项基金资助（基金编号：2014FB062）。
