Pathological findings of uterine tumors preoperatively diagnosed as red degeneration of leiomyoma by MRI.
Pathological findings of uterine tumors preoperatively diagnosed as red degeneration of leiomyoma by MRI.
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DOI：
10.1007/s00261-017-1126-3
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发表时间：
2017-07
期刊：
影响因子：
--
通讯作者：
Narumi Y
中科院分区：
文献类型：
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作者：
Nakai G;Yamada T;Hamada T;Atsukawa N;Tanaka Y;Yamamoto K;Higashiyama A;Juri H;Nakamoto A;Yamamoto K;Hirose Y;Ohmichi M;Narumi Y
平滑肌瘤的静脉梗死被称为平滑肌瘤红色变性（RDL），可能是急腹症的原因之一。虽然磁共振成像（MRI）是唯一的方式，可以描绘内部的情况下，平滑肌瘤，典型的MR表现，RDL有时确定偶然即使在无症状的患者。本研究的目的是阐明术前MRI诊断为RDL的子宫肿瘤的常见病理表现。2007年3月至2015年4月，我们通过MRI诊断了28例RDL。切除后进行病理学分析的10个病变被纳入研究，并由妇科病理学家进行审查。从MRI到手术的平均时间为4.7个月。除1例急性期切除的肿瘤外，在肿瘤的切面上未观察到典型的牛红色。所有MRI诊断为RDL的病变均具有与平滑肌瘤红色变性一致的共同病理学表现，包括凝固性坏死。除了广泛的凝固性坏死外，RDL的其他常见病理特征似乎是整个病变中缺乏炎性细胞浸润或出血。虽然已知RDL会引起急腹症，但即使在红色变性后很长时间才出现症状的无症状患者中也可以观察到其典型的MR表现。本研究中所发现之急性期及慢性期之典型病理表现，沿着影像学报告，将有助于妇科医师及病理医师怀疑红变病史及确诊。
Venous infarction of a leiomyoma is known as red degeneration of leiomyoma (RDL) and can be a cause of acute abdomen. Although magnetic resonance imaging (MRI) is the only modality that can depict the inner condition of a leiomyoma, the typical MR findings of RDL are sometimes identified incidentally even in asymptomatic patients. The purpose of this study is to clarify common pathological findings of uterine tumors preoperatively diagnosed as RDL by MRI. We diagnosed 28 cases of RDL by MRI from March 2007 to April 2015. The ten lesions subjected to pathological analysis after resection were included in the study and reviewed by a gynecological pathologist. The average time from MRI to operation was 4.7 months. The typical beefy-red color was not observed on the cut surface of the tumor except in one tumor resected during the acute phase. All lesions diagnosed as RDL by MRI had common pathological findings consistent with red degeneration of leiomyoma, including coagulative necrosis. Other common pathological features of RDL besides extensive coagulative necrosis appear to be a lack of inflammatory cell infiltrate or hemorrhage in the entire lesion. Although RDL is known to cause acute abdomen, its typical MR findings can be observed even in asymptomatic patients in a condition that manifests long after red degeneration. The characteristic pathological findings in both the acute phase and the chronic phase that we found in this study, along with radiology reports, will be helpful references for gynecologists and pathologists in suspecting a history of red degeneration and confirming the diagnosis.