目的：探讨儿童及青少年颅内生殖细胞瘤的临床表现及影像学特点，以提高对本病的认识。方法：回顾性分析45例经病理或随访证实的不同部位颅内生殖细胞瘤患者临床表现及影像学的特点。结果：7例（16%）位于松果体区，均为男性，平均11岁，主要临床表现为颅内高压（71%），3例行CT平扫，显示等高密度含钙化的类圆形肿块，MRI显示T1WI及T2WI等信号、DWI等（27%）或稍高（73%）信号的肿块，增强后明显强化。24例（53%）位于鞍区，75%为女性，平均10岁，主要临床表现为尿崩症（83%），6例行CT平扫，肿块显示为等高密度，但无一钙化，MRI显示94%为形态各异的肿块，其中36%伴小囊变，实性部分影像表现类似松果体区肿瘤，6%仅表现为垂体柄结节样增粗。10例（22%）位于丘脑基底节区，90%为男性，平均11岁，主要临床表现为轻偏瘫（70%），7例行CT平扫，显示肿块实性部分高密度，57%含钙化，MRI显示不规则的T1WI及T2WI等信号、DWI等（44%）或稍高（56%）信号，增强后中度强化，50%伴囊变或出血，38%伴偏侧脑萎缩。多中心病变占9%，75%为男性，临床表现与其中某一部位损害类似，影像学表现也与该部位特点相同。结论：10~12岁是颅内生殖细胞瘤主要发病年龄，松果体区、鞍区及丘脑基底节区为好发部位，松果体区及丘脑基底节区男性占绝对优势，不同部位生殖细胞瘤的临床及影像学表现各具特点，两者结合能提高对颅内生殖细胞瘤的诊断。
Abstract
Objective: In order to improve to know intracranial germinomas, its the clinical and imaging features in children and teenagers were studied. Methods: Clinical data and imaging studies were retrospectively analyzed in 45 patients, who confirmed by pathology or follow-up in different parts of intracranial germinomas. Results: Pineal region tumors accounted for 16%, all of them were males, with an average age of 11, 71% patients showed intracranial hypertension, 3 patients had CT scan, which showed equal or slightly higher density oval lumps, all with calcification. Isointensity was showed on MRI T1WI and T2WI. Isointensity was showed(27%) or slightly hyperintensity(73%) on DWI, and significant enhancement was seen. Sellar tumors accounted for 53%, 75% were females, with an average age of 10, 83% showed diabetes insipidus. Irregular mass covered 94%, 36% of the cases were with cystic change. The imaging features of sellar tumor is similar to pineal region tumor, but with no calcification. Stalk nodular covered 6%. Thalamus and basal ganglia tumors accounted for 22%, 90% were males, with an average age of 11, 70% showed hemiparesis. The solid part of the tumor showed high density with 57% patchy calcification on CT, T1WI showed hypointensity, T2WI and DWI showed hyperintensity with moderate enhancement, with 50% of cystic degeneration and hemorrhage, 38% with unilateral brain atrophy. Multi-center lesions accounted for 9%, 75% were males, these patients tend to present with symptoms associated with one part of the lesions. Conclusion: The mainly age of intracranial germinoma is from 10 to 12 years old. Pineal, sellar, thalamus and basal ganglia are the predilection sites, clinical and imaging findings in different parts of germinomas with different characteristics.
关键词
脑肿瘤 /
生殖细胞瘤 /
儿童 /
青少年 /
体层摄影术 /
螺旋计算机 /
磁共振成像
Key words
Brain neoplasms /
Germinoma /
Child /
Adolescent /
Tomography, spiral computed /
Magnetic resonance imaging
中图分类号：
Ｒ739.41
Ｒ814.42
Ｒ445.2
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