罕见纵隔原发性精原细胞瘤的 CT 表现及临床特点

摘要

Objective:To observe the CT and clinical characteristics of primary mediastinal seminoma. Methods:To retrospectively analyze clinical data of 5 cases confirmed by pathology patients with mediastinal seminoma imaging to observe the pathological changes of size,density,enhancement,boundary,pathology,imaging and clinical features,summarize the main points of diagnosis and differential diagnosis. Results:All lesions affected men aged 16 to 66 years old with median age of 27. Tumors were solid and irregular with huge volume of maximum diameter about 3. 5 ~9. 9cm,3 tumors located in the anterosuperior mediastinum,1 of whole and 1 of posterior mediastinal respectively. Symptoms were placeholder signs as chest pain or discomfort,head and neck swelling. CT showed even and hyperin-tensity tumors with mild enhancement for 2 cases,including 1 case appeared liver metastases 1 year after diagnosis. 3 tumors showed lower density area,the lower density can be seen in the other 3 tumors,the substantial part with mild or gradual enhanced compressed and displaced vessels in different degrees,especially vena cava. Some circuity vessels could be seen on one case and accompanied by the enlarged neck or axillary lymph node. Conclusion:For anterior mediastinum huge lump of male adolescents with those signs and exclusion of secondary lesions should take into ac-count the possibility of seminoma,such as uniform density and mild or moderate enhancement,vessels to varying de-grees within the lesion.%目的：观察纵隔原发性精原细胞瘤的 CT 表现及临床特点。方法：回顾性分析5例经病理证实的纵隔精原细胞瘤患者的影像学及临床资料，观察病变的大小、密度、强化、边界、病理等影像及临床特点，总结其诊断及鉴别诊断要点。结果：5例病变均发生于男性，年龄16~66岁，中位年龄27岁，病变形态不规则，其中前上纵隔3例，前中上纵隔及后纵隔各1例，体积巨大，最大径约3.5~9.9cm，症状以胸部不适、疼痛或头颈部憋胀等多见。2例病变呈均匀低密度影伴轻度强化，其中1例于确诊1年后出现肝脏转移灶；3例低密度病灶内可见点片状更低密度区，肿块实质呈轻度或渐进性强化，临近血管不同程度地受压移位，以腔静脉为著，其中1例病灶可见大量迂曲血管影，并伴有颈部或腋窝淋巴结肿大。结论：青少年男性伴有前纵隔巨大肿块，密度较均匀且轻中度强化，病灶内见不同程度血管影时，排除继发性病变外应考虑到精原细胞瘤的可能。