脐尿管癌临床、影像诊断(课堂PPT).pptVIP

早期无临床表现。 当病变突破膀胱黏膜时，最常见的症状为血尿。其次为腹痛、尿路刺激症状，部分患者可有脐部血性、脓性分泌物。 有文献报导肉眼下或镜下粘液尿比血尿出现早，更有价值，但发生率仅为25%。 北京大学第三医院放射科 临床表现 * Company Logo 病理类型 粘液腺癌（最常见）：部分癌细胞胞质内可见粘液分泌性空泡状结构，部分病例细胞核呈印戒状。 未特殊分类腺癌：癌细胞呈腺样排列，腺腔大小不等，形态不规则。 移行细胞癌 鳞状细胞癌 小细胞癌 北京大学第三医院放射科 病理 * Company Logo 区分脐尿管腺癌与原发性膀胱腺癌一直是临床及病理学的难题．脐尿管癌病理诊断标准包括： 肿瘤位于膀胱顶部和前壁 残存脐尿管可见肿瘤 膀胱黏膜无腺性膀胱炎和囊性膀胱炎改变 除外转移性腺癌 北京大学第三医院放射科 病理 * Company Logo 肿块位于膀胱顶部或前壁沿腹中线略偏一侧。 肿块可为囊性、实性、囊实性。60%的肿块可见低密度（在病理上为粘液成分），50-70%可见钙化灶。 增强扫描囊性部分有絮状强化或无强化，实性部分有明显不均匀强化。 浸润性生长，可侵犯膀胱、脐周组织、腹直肌。 北京大学第三医院放射科 CT表现 * Company Logo 北京大学第三医院放射科 46岁，男 (a) was seen a large heterogeneous solid mass, with areas of low attenuation and dystrophic calcifications, suggestive of mucin content. (b) reformatted CT images, revealed the mass located superior to the bladder and extending through the right flank. The lesion contact the bladder but no focal thickening of the bladder wall was evident * Company Logo 北京大学第三医院放射科 Mucinous adenocarcinoma arising from the urachal remnant in a 38-year-old woman (b) Contrast-enhanced CT scan shows a low-attenuation mass with thin, curvilinear calcifications peripherally (arrowheads). ut uterus. (c) CT scan obtained 2 cm lower than b shows a solid, high-attenuation mass with a smooth posterior border (arrowheads) contiguous with the dome of the bladder (bl ). Small, punctate calcifications are also seen in the center of the lesion. * Company Logo 北京大学第三医院放射科 55-year-old woman，(b, c) Contrast-enhanced CT scans (c obtained at a lower level than b) show a well-defined mass (arrowheads) overlying the right anterosuperior aspect of the bladder (bl). The tumor is deviated to the right side rather than being in the typical midline location. Note the extravesical component with inhomogeneous attenuation and an intravesical component with relatively homogeneous high attenuation. * Company Logo 囊性成分呈长T1长T2改变 实性成分为略长T1信号、等T1、长T2信号影。 增强扫描实性成分有强化，囊性成分无强化或是片絮状强化。 北京大学第三医院放射科 MRI表现 * Company Logo MR revealed an inhomogeneous mass with