- 期刊
Ultrasonographic Characteristics in a Primary Liposarcoma of the Anterior Mediastinum with Tumor Emboli and Infarction
縱膈腔原發惡性脂肪肉瘤伴隨腫瘤血管栓塞之獨特超音波影像學特徵
摘要
原發於縱膈腔之惡性脂肪肉瘤是十分罕見的病例，僅佔所有縱膈腔腫瘤的百分之一不到，而其預後主要決定於病理組織學型態。灰階及都普勒 (Doppler) 超音波影像學目前廣泛應用於各種胸腔疾患的診斷，然而縱膈腔原發惡性脂肪肉瘤的超音波影像學表現，過去則尚無文獻報告。在本病案報告中，我們描述了一個縱膈腔原發惡性脂肪肉瘤之獨特超音波影像學特徵及其與相對之放射影像學和病理組織學表現的關聯性。該病患為四十六歲男性，於健檢時由胸部x光片檢出一個巨大的縱膈腔腫瘤。灰階超音波影像中，該腫瘤之質地十分細密，呈現出高迴音強度及異質性的特徵，這樣的表現在其它的胸部病灶是十分罕見的。彩色都普勒超音波影像檢查下，其中心部血流信號相當少，而周邊部之血流信號型態呈現典型的「高速低阻抗流動型態」，收縮期尖峰流速 (peak systolic velocity) 為0.73米/秒，阻抗指數 (resistive index) 為0.46，脈衝指數 (pulsitility index) 則為0.62，此「高速低阻抗流動型態」為惡性腫瘤血管之特異表現，用來分別良性或惡性腫瘤有很好的鑑別力。電腦斷層掃描發現該腫瘤有被膜包覆，其訊號衰減約等同於皮下脂肪組織。病患接受腫瘤全切除術。該腫瘤尺寸約23×23×7公分見方，組織學表現為分化良好之惡性脂肪肉瘤、類脂肪瘤亞型 (lipoma-like subtype)，光學顯微鏡下可見脂肪母細胞及未分化之巨核細胞散在分化良好之脂肪中，血管壁處處可見腫瘤細胞浸潤及栓塞，相鄰於血管栓塞部之腫瘤呈現廣泛的栓塞及壞死。總結以上發現，縱膈腔惡性脂肪肉瘤之超音波影像學表現十分特殊，並和放射影像學及病理組織學之表現有很好的關聯性，應用於縱膈腔惡性脂肪肉瘤有很高的診斷價值，縱膈腔腫瘤若在超音波影像學中表現出細質地、高迴音強度、異質性、高速低阻抗血流型態的特徵，應於鑑別診斷中優先考慮惡性脂肪肉瘤。
並列摘要
We report a case of primary liposarcoma of the anterior mediastinum, a relatively uncommon neoplasm, in which the ultrasonographic findings were characteristic. A 46-year-old man was found to have a huge mediastinal mass during a health check-up. On the gray scale ultrasonography, the tumor appeared fine in texture. The echogenicity of the tumor was heterogeneous and hyperechoic. The Doppler study of the blood vessels in the tumor exhibited a characteristic low-impedance high-velocity flow pattern (peak systolic velocity 0.73 m/sec, resistive index 0.46, pulsatility index 0.62). He then underwent a total excision of the tumor. The histological examination revealed a well-differentiated liposarcoma of a lipoma-like subtype with scattered tumor emboli resulting in areas of infarction. In summary, a mediastinal tumor showing high echogenicity and a fine texture on gray scale ultrasonography and a low-impedance high-velocity flow pattern on Doppler imaging is highly suggestive of a liposarcoma.
延伸閱讀
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