[教育]原發(fā)性輸卵管癌的mr表現(xiàn)

1、Primary fallopian tube carcinoma（PFTC）原發(fā)性輸卵管癌,,Epidemiology,PFTC is one of the rarest malignancies of the female genital tract, accounting for 0.14-1.8% of all gynaecological malignancies（婦科惡性腫瘤）.occurring predominantly

2、 in post-menopausal women at a mean age of 55 years, with women of higher social classes and education being at greater risk.,Clinical presentation,aetiology（病因?qū)W）hormonal（激素）, reproductive（生殖的）, genetic factors may play

3、 a role, along with the presence of chronic inflammation of the pelvis.,Clinical presentation,Characteristic symptoms (Laztko's triad, seen in only 15% of patients)colicky(疝氣樣) abdominal or pelvic painadnexal(附件的)

4、massrelieved by intermittent, profuse(大量的), serosanguineous vaginal discharge(陰道排液),Clinical presentation,Hydrops tube profluens(輸卵管積水)：seen in only 5% of patientsThe age of presentation is commonly between 40 and 60 y

5、ears, with a mean age of 55 years.,Clinical presentation,The pre-operative diagnosis of PFTC is rarely performed, with clinical signs and symptoms pointing towards the more frequently occurring ovarian cancer or pelvic

6、inflammatory disease. Elevated CA-125 levels are indicative of poor prognosis, and can be used during follow-up, as a marker of disease recurrence,Pathological diagnosis,Serous carcinoma(漿液性癌) of the fallopian tube is t

7、he most common histological typeThe second most common type of tumour is the endometrioid carcinoma(子宮內(nèi)膜樣癌), followed by undifferentiated, clear cell, mucinous, and transitional carinomas.,Pathological diagnosis,diagnos

8、is criteria of PFTCthe main tumour arises from the endosalpinx(輸卵管內(nèi)膜)the histological pattern reproduces the epithelium of the tubal mucosathe transition from benign to malignant tubal epithelium is demonstrablethe o

9、varies or endometrium are either normal or contain a tumour that is smaller than the tumour in the tube,Pathological diagnosis,Dissemination(播散) of PFTCimplantation of cells throughout the abdominal cavitythrough conti

10、nuity adjacent organstransluminal migration（經(jīng)腔轉(zhuǎn)移）haematogenouslymphatic spreaddistant metastases,Treatment,surgical approachtotal abdominal hysterectomy(子宮切除術(shù))bilateral salpingo-oophorectomy（輸卵管-卵巢切除術(shù)）infra-colic

11、omentectomy（結(jié)腸以下網(wǎng)膜切除術(shù)）, appendicectomy, peritoneal washings, peritoneal biopsies.Routine pelvic and para-aortic lymphadenectomy,Treatment,Postoperatively, chemotherapy plays an important role in the management of early-

12、stage PFTCHormonal therapies may be of value in the future, given the sensitivity and response of the fallopian tube epithelium to hormonal fluctuations,Prognosis,The main prognostic factors identified for increased sur

13、vival include stage, age, and residual tumour after surgery, serous subtype, and elevated pre-treatment CA-125.The 5-year survival rate of PFTC ranges between 22-57%.,Imaging PFTC,The characteristic appearance of PFTCd

14、irect signs: relative small, tubular-shaped (or sausage-shaped臘腸樣) manssinhomogenous signal, low signal intensity on T1WI, isointensity to slight hyperintensity on T2WI, high signal in DWImild to moderate enhancementi

15、ndirect signs: hydrosalpinx（輸卵管積水） or intra-uterine fluid,Anatomy of the fallopian tubes on MRI,The normal fallopian tubes are usually not visualized on pelvic MRI.In the presence of intraperitoneal fluid, they may be s

16、een as paired thin structures, extending from the ovaries to the uterine cornua, in the superior edge of the broad ligament.,Anatomy of the fallopian tubes on MRI,10-12cmdivided into four portionsintramural/interstitia

17、l on the medial endthe isthmusthe ampullathe infundibulum at the lateral fimbriated end,Anatomy of the fallopian tubes on MRI,,Tubular/sausage-shaped mass,,,A 52-year-old woman with a primary fallopian tube carcinoma

18、on the left side. Sagittal turbo SE T2WI with fat saturation (a) shows a sausage-like solid mass (arrow) with slightly hyperintense signal and moderate enhancement on contrast-enhanced FLASH 2D T1WI with fat saturation (

19、b).,A 62-year-old woman with a primary fallopian tube carcinoma on the left side. Axial SE T1WI (a), turbo SE T2WI with fat saturation (b), and contrast-enhanced FLASH 2D T1WI with fat saturation (c),An 81-year-old woman

20、 with a primary fallopian tube carcinoma on the right side.,MRI for differentiating primary fallopian tube carcinoma from epithelial ovarian cancer,Significant differences between PFTC and EOC were found in the size, sha