乳腺外佩吉特病的超声特征
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摘要
目的探讨乳腺外佩吉特病(EMPD)的超声声像图特征。方法回顾性分析经病理证实的41例EMPD患者的超声资料及声像图特征。结果 41例中,病灶位于外阴33例,腹股沟2例,肛周2例,上胸壁1例,下腹壁1例,额部1例,拇指1例。超声检出病变36例,根据形态可分为弥漫型和肿块型。弥漫型31例,均表现为形态不规则、边缘不清的弥漫性病变,超声显示皮肤增厚30例,无增厚1例;病灶呈低回声8例,稍低回声23例;CDFI血流分级0级2例,1级6例,2级11例,3级12例;腹股沟淋巴结异常9例。肿块型5例,均表现为边缘清晰的肿块样病变,超声显示皮肤增厚1例,无增厚4例;肿块内部呈低回声3例,稍低回声2例;形态规则4例,不规则1例;CDFI血流分级0级1例,1级2例,2级1例,3级1例;腹股沟淋巴结异常3例。5例(5/41,12.20%)超声未见明显异常。结论超声可敏感识别EMPD病变区回声异常及血流异常,诊断EMPD需结合临床表现。
Objective To explore the ultrasonographic features of extramammary Paget's disease (EMPD).MethodsThe ultrasonographic data of 41 patients with EMPD confirmed by pathology were retrospectively analyzed,and the ultrasonographic features of EMPD were observed.Results Among the 41 patients of EMPD,lesions located at vulva in33 cases,at groin in 2,at perianal in 2cases,while at upper chest wall,lower abdominal wall,forehead and thumb in 1case,respectively.Among 36 patients with ultrasonographic found lesions,EMPD could be divided into diffuse type and mass type according to the morphology of the lesions.There were 31 diffuse type lesions with irregular shape and unclear margin.Ultrasound showed skin thickening in 30 lesions and no thickening in 1,hypoechoic echo in 8and slightly hypoechoic echo in 23,while CDFI blood flow demonstrated grade 0 in 2,grade 1in 6,grade 2in 11,grade 3in 12.Inguinal abnormal lymph nodes were found in 9patients with diffuse type EMPD.There were 5patients of mass type EMPD with clear margins,among them ultrasound showed 1patient with skin thickening and 4without thickening,and hypoechoic lesions were found in 3patients and slightly hypoechoic lesions in 2patients.The shape of 4lesions were regular and 1was irregular,1lesion with CDFI blood flow of grade 0,2of grade 1,1of grade 2,1of grade 3.The abnormal inguinal lymph nodes were found in 3patients.Ultrasonography showed no obvious abnormality in the other 5patients (5/41,12.20%).Conclusion Ultrasound could sensitively identify abnormal echo and blood flow in EMPD lesions.Clinical manifestations should be considered in ultrasound diagnosis of EMPD.
Objective To explore the ultrasonographic features of extramammary Paget's disease (EMPD).MethodsThe ultrasonographic data of 41 patients with EMPD confirmed by pathology were retrospectively analyzed,and the ultrasonographic features of EMPD were observed.Results Among the 41 patients of EMPD,lesions located at vulva in33 cases,at groin in 2,at perianal in 2cases,while at upper chest wall,lower abdominal wall,forehead and thumb in 1case,respectively.Among 36 patients with ultrasonographic found lesions,EMPD could be divided into diffuse type and mass type according to the morphology of the lesions.There were 31 diffuse type lesions with irregular shape and unclear margin.Ultrasound showed skin thickening in 30 lesions and no thickening in 1,hypoechoic echo in 8and slightly hypoechoic echo in 23,while CDFI blood flow demonstrated grade 0 in 2,grade 1in 6,grade 2in 11,grade 3in 12.Inguinal abnormal lymph nodes were found in 9patients with diffuse type EMPD.There were 5patients of mass type EMPD with clear margins,among them ultrasound showed 1patient with skin thickening and 4without thickening,and hypoechoic lesions were found in 3patients and slightly hypoechoic lesions in 2patients.The shape of 4lesions were regular and 1was irregular,1lesion with CDFI blood flow of grade 0,2of grade 1,1of grade 2,1of grade 3.The abnormal inguinal lymph nodes were found in 3patients.Ultrasonography showed no obvious abnormality in the other 5patients (5/41,12.20%).Conclusion Ultrasound could sensitively identify abnormal echo and blood flow in EMPD lesions.Clinical manifestations should be considered in ultrasound diagnosis of EMPD.
引文
[1]杨旭丹,傅静,王雷,等.原发性乳腺外Paget病49例临床病理分析.诊断病理学杂志,2017,24(4):245-248.
[2]Adler DD,Carson PL,Robin JM,et al.Doppler ultrasound color flow imaging in the study of breast cancer:Preliminary findings.Ultrasound Med Biol,1990,16(6):553-559.
[3]Kurman RJ,Carcangiu ML,Herrington CS,et al.WHOclassification of tumours female reproducetive organs.Lyon:IARC Press,2014:236-237.
[4]Kang Z,Zhang Q,Zhang Q,et al.Clinical and pathological characteristics of extramammary Paget's disease:Report of 246Chinese male patients.Int J Clin Exp Pathol,2015,8(10):13233-13240.
[5]郭亮侬,刘小青,李航,等.乳房外Paget病75例临床病理特点分析.中华医学杂志,2015,95(22):1751-1754.
[6]周庚寅,翟启辉,张庆慧.诊断免疫组织化学.2版.北京:北京大学医学出版社,2008:406-410.
[7]Hatta N,Yamada M,Hirano T,et al.Extramammary Paget's disease:Treatment,prognostic factors and outcome in 76patients.Br J Dermatol,2008,158(2):313-318.
[8]Yasuhiro I,Satomi I,Yasushi Y,et al.Prognostic indicators in35patients with extramammary Paget's disease.Dermatol Surg,2012,38(12):1938-1944.
[9]周璟.高频超声的常见皮肤肿瘤表现及在基底细胞癌术前评估的应用研究.天津:天津医科大学,2016:1-58.
[10]De Magnis A,Checcucci V,Catalano C,et al.Vulvar paget disease:A large single-centre experience on clinical presentation,surgical treatment,and long-term outcomes.JLow Genit Tract Dis,2013,17(2):104-110.
[11]Lai YL,Yang WG,Tsay PK,et al.Penoscrotal extramammary Paget's disease:A review of 33cases in a 20-year experience.Plast Reconsrt Sury,2003,112(4):1017-1023.
[2]Adler DD,Carson PL,Robin JM,et al.Doppler ultrasound color flow imaging in the study of breast cancer:Preliminary findings.Ultrasound Med Biol,1990,16(6):553-559.
[3]Kurman RJ,Carcangiu ML,Herrington CS,et al.WHOclassification of tumours female reproducetive organs.Lyon:IARC Press,2014:236-237.
[4]Kang Z,Zhang Q,Zhang Q,et al.Clinical and pathological characteristics of extramammary Paget's disease:Report of 246Chinese male patients.Int J Clin Exp Pathol,2015,8(10):13233-13240.
[5]郭亮侬,刘小青,李航,等.乳房外Paget病75例临床病理特点分析.中华医学杂志,2015,95(22):1751-1754.
[6]周庚寅,翟启辉,张庆慧.诊断免疫组织化学.2版.北京:北京大学医学出版社,2008:406-410.
[7]Hatta N,Yamada M,Hirano T,et al.Extramammary Paget's disease:Treatment,prognostic factors and outcome in 76patients.Br J Dermatol,2008,158(2):313-318.
[8]Yasuhiro I,Satomi I,Yasushi Y,et al.Prognostic indicators in35patients with extramammary Paget's disease.Dermatol Surg,2012,38(12):1938-1944.
[9]周璟.高频超声的常见皮肤肿瘤表现及在基底细胞癌术前评估的应用研究.天津:天津医科大学,2016:1-58.
[10]De Magnis A,Checcucci V,Catalano C,et al.Vulvar paget disease:A large single-centre experience on clinical presentation,surgical treatment,and long-term outcomes.JLow Genit Tract Dis,2013,17(2):104-110.
[11]Lai YL,Yang WG,Tsay PK,et al.Penoscrotal extramammary Paget's disease:A review of 33cases in a 20-year experience.Plast Reconsrt Sury,2003,112(4):1017-1023.