原發(fā)性輸卵管癌的MR表現(xiàn)課件

1、原發(fā)性輸卵管癌的MR表現(xiàn)原發(fā)性輸卵管癌的MR表現(xiàn)EpidemiologyPFTC is one of the rarest malignancies of the female genital tract, accounting for 0.14-1.8% of all gynaecological malignancies（婦科惡性腫瘤）.occurring predominantly in post-menopausal women at a mean age of 55 years, with women of higher social classes and education be

2、ing at greater risk.EpidemiologyPFTC is one of theClinical presentationaetiology（病因?qū)W）hormonal（激素）, reproductive（生殖的）, genetic factors may play a role, along with the presence of chronic inflammation of the pelvis.Clinical presentationaetiologyClinical presentationCharacteristic symptoms (Laztkos tri

3、ad, seen in only 15% of patients)colicky(疝氣樣) abdominal or pelvic painadnexal(附件的) massrelieved by intermittent, profuse(大量的), serosanguineous vaginal discharge(陰道排液)Clinical presentationCharacterClinical presentationHydrops tube profluens(輸卵管積水)：seen in only 5% of patientsThe age of presentation is

4、 commonly between 40 and 60 years, with a mean age of 55 years.Clinical presentationHydrops tClinical presentationThe pre-operative diagnosis of PFTC is rarely performed, with clinical signs and symptoms pointing towards the more frequently occurring ovarian cancer or pelvic inflammatory disease. El

5、evated CA-125 levels are indicative of poor prognosis, and can be used during follow-up, as a marker of disease recurrenceClinical presentationThe pre-Pathological diagnosisSerous carcinoma(漿液性癌) of the fallopian tube is the most common histological typeThe second most common type of tumour is the e

6、ndometrioid carcinoma(子宮內(nèi)膜樣癌), followed by undifferentiated, clear cell, mucinous, and transitional carinomas.Pathological diagnosisSerous cPathological diagnosisdiagnosis criteria of PFTCthe main tumour arises from the endosalpinx(輸卵管內(nèi)膜)the histological pattern reproduces the epithelium of the tuba

7、l mucosathe transition from benign to malignant tubal epithelium is demonstrablethe ovaries or endometrium are either normal or contain a tumour that is smaller than the tumour in the tubePathological diagnosisdiagnosiPathological diagnosisDissemination(播散) of PFTCimplantation of cells throughout th

8、e abdominal cavitythrough continuity adjacent organstransluminal migration（經(jīng)腔轉(zhuǎn)移）haematogenouslymphatic spreaddistant metastasesPathological diagnosisDisseminTreatmentsurgical approachtotal abdominal hysterectomy(子宮切除術(shù))bilateral salpingo-oophorectomy（輸卵管-卵巢切除術(shù)）infra-colic omentectomy（結(jié)腸以下網(wǎng)膜切除術(shù)）, appe

9、ndicectomy, peritoneal washings, peritoneal biopsies.Routine pelvic and para-aortic lymphadenectomyTreatmentsurgical approachTreatmentPostoperatively, chemotherapy plays an important role in the management of early-stage PFTCHormonal therapies may be of value in the future, given the sensitivity and

10、 response of the fallopian tube epithelium to hormonal fluctuationsTreatmentPostoperatively, chemPrognosisThe main prognostic factors identified for increased survival include stage, age, and residual tumour after surgery, serous subtype, and elevated pre-treatment CA-125.The 5-year survival rate of

11、 PFTC ranges between 22-57%.PrognosisThe main prognostic fImaging PFTCThe characteristic appearance of PFTCdirect signs: relative small, tubular-shaped (or sausage-shaped臘腸樣) manssinhomogenous signal, low signal intensity on T1WI, isointensity to slight hyperintensity on T2WI, high signal in DWImild

12、 to moderate enhancementindirect signs: hydrosalpinx（輸卵管積水） or intra-uterine fluidImaging PFTCThe characteristicAnatomy of the fallopian tubes on MRIThe normal fallopian tubes are usually not visualized on pelvic MRI.In the presence of intraperitoneal fluid, they may be seen as paired thin structure

13、s, extending from the ovaries to the uterine cornua, in the superior edge of the broad ligament.Anatomy of the fallopian tubesAnatomy of the fallopian tubes on MRI10-12cmdivided into four portionsintramural/interstitial on the medial endthe isthmusthe ampullathe infundibulum at the lateral fimbriate

14、d endAnatomy of the fallopian tubesAnatomy of the fallopian tubes on MRIAnatomy of the fallopian tubesTubular/sausage-shaped massTubular/sausage-shaped mass A 52-year-old woman with a primary fallopian tube carcinoma on the left side. Sagittal turbo SE T2WI with fat saturation (a) shows a sausage-li

15、ke solid mass (arrow) with slightly hyperintense signal and moderate enhancement on contrast-enhanced FLASH 2D T1WI with fat saturation (b). A 52-year-old woman with a prA 62-year-old woman with a primary fallopian tube carcinoma on the left side. Axial SE T1WI (a), turbo SE T2WI with fat saturation

16、 (b), and contrast-enhanced FLASH 2D T1WI with fat saturation (c)A 62-year-old woman with a priAn 81-year-old woman with a primary fallopian tube carcinoma on the right side. An 81-year-old woman with a prMRI for differentiating primary fallopian tube carcinoma from epithelial ovarian cancerSignificant differences between PFTC and EOC were found in the size, shape,