MRI and CT Manifestation and Clinical Features of Ovarian Sertoli-Leydig Cell Tumor
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摘要:
目的：总结卵巢支持-间质细胞瘤（SLCT）的影像表现及临床特征，提高对本病的认识。方法：回顾性分析本院经手术及病理证实的15例SLCT患者的临床及影像学资料，其中15例均行MR扫描，5例同时行CT扫描。术前均行卵巢肿瘤标记物检测，10例行内分泌激素水平检测。结果：15例均为单侧单发病变，左侧8例，右侧7例，其中实性4例，囊实性11例。MRI表现：平扫实性成分呈等T1稍长T2信号为主，DWI高信号，ADC图信号减低，囊性成分呈长T1长T2信号；增强扫描4例实性肿瘤明显强化，11例囊实性中5例实性成分呈结节样、不规则分隔样或囊壁样明显强化，另6例呈混合强化，其中1例病理为中分化，余5例为中低及低分化。CT表现：实性部分呈软组织密度，液性部分呈水样密度。3例实性肿瘤增强扫描明显强化，2例囊实性肿瘤中1例实性成分明显强化，1例混合强化。激素水平检测结果9例睾酮升高，肿瘤标记物检测结果3例AFP水平升高，3例CA125升高，1例CA199升高。10例患者表现为雄激素刺激相关表现，2例雌激素刺激相关表现，2例为雌雄激素共同作用表现，1例无症状。病理结果2例为高分化SLCT，7例中分化，5例中低分化，1例低分化。结论：卵巢SLCT具有一定的影像及临床特征，呈实性或囊实性肿块，增强扫描实性成分呈明显强化或混合强化，中低或低分化者多呈混合强化；常伴有激素刺激相关表现，以雄激素刺激相关表现多见。
Abstract:Objective: To summarize the imaging and clinical features of ovarian Sertoli–Leydig cell tumors (SLCT) to improve our understanding of the disease. Methods: The clinical and imaging data of 15 patients with SLCT confirmed by surgery and pathology were analyzed retrospectively. All patients underwent contrast-enhanced MRI, and five patients underwent contrast-enhanced CT. The expression levels of tumor markers and endocrine hormones were detected in 15 and 10 patients, respectively. Results: All 15 cases of SLCT were unilateral: 8 tumors in the left accessory and 7 tumors in the right accessory, and 4 solid tumors and 11 cystic solid tumors. MRI findings showed that solid components in masses were mainly indicated by intermediate intensity on T1WI and slight hyperintensity on T2WI, while cystic components were indicated by hypo-signal on T1WI and hyper-signal on T2WI. Solid components showed hyper-signals on DWI and hypo-signals on the ADC map. Four cases of solid tumors showed marked enhancement; all the solid components in five cases of cystic solid tumors showed marked enhancement, presenting as nodular, irregular septa, or cystic wall; and the other six cases of cystic solids showed mixed enhancement after administration of contrast medium. Among the six cases of mixed enhancement, five were moderately to poorly differentiated, and one was moderately differentiated. CT findings revealed that the solid components had soft tissue density, whereas cystic components had watery density. Three cases of solid tumors showed marked enhancement, while two cases of cystic solid tumors showed marked enhancement of the solid components or mixed enhancement. Nine patients had increased testosterone levels . Three patients had elevated AFP levels, two had elevated CA125 levels, and one had raised CA199 levels. Ten patients presented with androgen stimulation-related symptoms, two with estrogen stimulation-related symptoms, two with the co-action of estrogen and androgen and one without symptoms. Histopathological results showed that two cases were highly differentiated, seven were moderately differentiated, five were moderately to poorly differentiated, and one was poorly differentiated. Conclusion: SLCT presents as a solid or cystic solid mass, and solid components show either marked or mixed enhancement. Patients with moderate-to-poor and poor differentiation may present with mixed enhancement. SLCT often presents with symptoms related to stimulation of hormones, most commonly androgen.
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Keywords:
- tomography /
- X-ray computed /
- Sertoli-Leydig cell tumor /
- magnetic resonance imaging
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图 1 左卵巢高分化SLCT
注：（a）轴位脂肪抑制 T2WI 示左侧附件区实性结节，呈稍长 T2 信号为主；（b）轴位增强图像示结节明显强化，内见少许条索样低强化；（c）DWI（b=10 001 000 s/mm2） 示结节呈高信号；（d）ADC 图示结节信号减低。
Figure 1. Image of highly differentiated SLCT in the left accessory
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图 2 右卵巢中低分化SLCT
注：（a）轴位脂肪抑制T2WI示子宫前方囊实性结节，囊性为主；（b）轴位DWI图（b=1 000 s/mm²），示肿瘤实性部分呈高信号；（c）和（d）轴位、冠状位增强图像示肿块内不规则分隔、囊壁明显强化，局部结节样强化，右侧卵巢血管增粗提示肿块位于右侧。
Figure 2. Image of moderately to poorly differentiated SLCT in the right accessory
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图 3 左卵巢低分化SLCT
注：（a）轴位T1WI示盆腔内囊实性结节，实性成分呈等T1信号，囊性成分呈长T1信号；（b）轴位脂肪抑制T2WI示实性成分呈较长T2信号，囊性成分呈长T2信号；（c）和（d）轴位、冠状位增强图像示肿块内见结节样、不规则分隔、囊壁样不均匀强化，局部呈“花环”样表现。（e）和（f）同一患者轴位CT平扫、增强图像示左附件囊实性肿块，增强扫描见结节样、囊壁样强化，左侧卵巢血管增粗提示肿块位于左侧。
Figure 3. Image of poorly differentiated SLCT in the left accessory
表 1 15例SLCT临床表现和实验室检查结果
Table 1 Clinical manifestations and laboratory examination results of 15 patients with SLCT
患者编号 年龄/岁 临床表现 异常血清激素水平 肿瘤标记物检查 1 31 多囊卵巢综合征1年余，下腹坠胀1月余 睾酮Ⅱ：4.94 nmol/L CA125：34 U/mL 2 56 体检发现，无症状 * - 3 24 月经失调、增多数月 - CA199：32.83 U/mL 4 51 绝经后阴道不规则出血 睾酮Ⅱ：1.82 nmol/L - 5 37 闭经5月余 睾酮Ⅱ：2.59 nmol/L - 6 13 月经量减少伴下腹痛 睾酮：7.61 nmol/L - 7 27 继发性闭经10月余 睾酮Ⅱ：14.2 nmol/L - 8 58 绝经后出血数月余 睾酮Ⅱ：7.38 nmol/L - 9 51 体检发现，嗓音改变10月余 睾酮：5020 pg/mL AFP：11.56 ng/mL 10 23 闭经3个月 * AFP：9.4 ng/mL 11 35 经量减少半年 * AFP：60.91 ng/mL 12 39 闭经3个月 - CA125：48.49 U/mL 13 27 闭经9个月 睾酮Ⅱ：2.76 nmol/L CA125：48.1 U/mL 14 55 绝经后出血 * - 15 36 闭经3年 睾酮Ⅱ：14.87 nmol/L - 注：“*”为未行此检测，“-”为结果为阴性。由于检测设备或地点不同观察指标名称、单位和正常值参考区间不同。 
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表 2 15例SLCT患者的影像表现及病理结果
Table 2 Imaging manifestations and pathological results of 15 patients with SLCT
患者
编号病灶
长径/cm病理（分化
程度）质地 实性部分T1WI 实性部分T2WI 实性部分强化特征及程度 实性部分DWI ADC值
（×10-3 mm²/s）实性部分
CT平扫CT值/HU静脉期CT值
/HU1 8.9 中-低分化伴网状型 囊实性 等 稍高 不规则分隔样、囊壁样强化；混合强化 高 1.100 * * 2 4.8 中-低分化 囊实性，实性为主 等 稍高 实性结节样强化，中心伴囊变；混合强化 高 0.593 * * 3 5.6 高分化 囊实性，实性为主 等 较高 实性结节样强化，伴小囊变及条索样低强化；明显强化 高 1.467 * * 4 3 高分化 实性 等 稍高 实性结节样强化，伴少许条索样低强化；明显强化 高 1.350 * * 5 5.8 中-低分化 囊实性 等 稍高 不规则分隔样、囊壁样、结节样强化，见花环样表现；混合强化 高 1.050 * * 6 9.3 中-低分化 囊实性，囊性为主 等 稍高 不规则分隔样、囊壁样强化；明显强化 高 1.100 * * 7 4.5 中分化 实性 等 稍高 实性结节样强化，伴条索样低强化；明显强化 高 1.234 * * 8 3.2 中分化 囊实性 等 稍高 实性结节样强化，伴小囊变；明显强化 高 1.220 35 110 9 4.8 中分化 囊实性，囊性为主 等 稍高 不规则分隔样、囊壁样强化；明显强化 高 1.167 * * 10 10.1 中-低分化 囊实性 等 稍高 不规则分隔样、囊壁样及结节样强化；混合强化 高 0.727 * * 11 4 中分化，可见异源成分 囊实性，实性为主 等 稍高 实性结节样强化，伴多发囊变；明显强化 高 0.796 * * 12 7.3 中分化 囊实性 等 较高 不规则分隔样、囊壁样强化；混合强化 高 1.039 37 117 13 10.5 低分化伴网状型 囊实性 等 较高 不规则分隔样、囊壁样、结节样强化，见花环样表现；混合强化 高 0.947 29～38 56～110 14 1 中分化 实性 等 稍高 结节样强化；明显强化 高 1.090 34 101 15 4 中分化 实性 等 较高 实性结节样强化，伴少许条索样低强化；明显强化 高 1.547 38 91 注：“*”为未行此检测。
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