切换至 "中华医学电子期刊资源库"

中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (08) : 813 -817. doi: 10.3877/cma.j.issn.1672-6448.2022.08.015

腹部超声影像学

肛瘘相关黏液腺癌的临床和超声影像特征
张光晨1, 崔立莎2, 王建新1, 初银珠1, 吴长君1,()   
  1. 1. 150001 哈尔滨医科大学附属第一医院超声科
    2. 150000 哈尔滨市第一医院消化内科
  • 收稿日期:2021-01-13 出版日期:2022-08-01
  • 通信作者: 吴长君

Clinical and ultrasonographic features of mucinous adenocarcinoma arising from anal fistula

Guangchen Zhang1, Lisha Cui2, Jianxin Wang1, Yinzhu Chu1, Changjun Wu1,()   

  1. 1. Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
    2. Department of Gastroenterology, Harbin First Hospital, Harbin 150000, China
  • Received:2021-01-13 Published:2022-08-01
  • Corresponding author: Changjun Wu
引用本文:

张光晨, 崔立莎, 王建新, 初银珠, 吴长君. 肛瘘相关黏液腺癌的临床和超声影像特征[J/OL]. 中华医学超声杂志(电子版), 2022, 19(08): 813-817.

Guangchen Zhang, Lisha Cui, Jianxin Wang, Yinzhu Chu, Changjun Wu. Clinical and ultrasonographic features of mucinous adenocarcinoma arising from anal fistula[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(08): 813-817.

目的

探讨肛瘘相关黏液腺癌的临床和超声影像特征。

方法

收集2014年5月至2020年12月于哈尔滨医科大学附属第一医院经手术病理确诊为肛瘘相关黏液腺癌的患者11例。所有患者术前均接受了经直肠超声、腹股沟淋巴结超声和肠镜检查,分析所有患者的临床和超声影像特征。

结果

所有患者的血清癌胚抗原(CEA)均有不同程度的升高,范围4.26~34.8 ng/ml(正常值为0~3.4 ng/ml),平均值为(12.3±8.4)ng/ml。所有患者的超声表现均为沿瘘管生长的海绵样混合回声团块,其中4例出现了腹股沟淋巴结转移。

结论

经直肠超声对于肛瘘相关黏液腺癌的诊断具有较好的应用价值,与血清CEA相结合,可能有助于提高诊断准确性。

Objective

To investigate the clinical and ultrasonographic features of mucinous adenocarcinoma arising from anal fistula.

Methods

From May 2014 to December 2020, 11 patients with mucinous adenocarcinoma arising from anal fistula diagnosed by pathology at the First Affiliated Hospital of Harbin Medical University were collected. All patients underwent transrectal ultrasound, inguinal lymph node ultrasound, and enteroscopy before operation, and the clinical and ultrasonic image characteristics of all patients were analyzed.

Results

Serum carcinoembryonic antigen (CEA) levels in all patients increased in varying degrees, ranging from 4.26 to 34.8 ng/ml (normal value: 0 to 3.4 ng/ml), with an average value of (12.3±8.4) ng/ml. The sonographic findings of all patients were sponge-like solid-cystic masses growing along the fistula, of which four cases had inguinal lymph node metastasis.

Conclusion

Transrectal ultrasound has good value in the diagnosis of mucinous adenocarcinoma arising from anal fistula. Transrectal ultrasound combined with serum CEA may help to improve the diagnostic accuracy.

图1 肛瘘病灶大体外观示外口处可见黏液和血性分泌物(箭头所示)
图2 肛瘘病灶大体外观示外口处可见隆起型包块(箭头所示)
表1 11例肛瘘相关MA患者的临床资料和超声表现
图3 经直肠超声示病灶沿瘘管生长(白色箭头为病灶,绿色三角为瘘管)
图4 经直肠超声示病灶内见大小不等的囊性小房,呈海绵样改变(白色箭头为病灶)
图5 经直肠超声示病灶后方回声增强(白色箭头所示)
图6 经直肠超声示病灶实性部分可见丰富血流信号(白色箭头所示)
图7 误诊为肛瘘相关黏液腺癌病灶的经直肠超声图像。超声示病灶内薄而均匀的分隔(白色箭头所示)和实性部分(绿色三角所示),其中实性部分未见血流信号,术后病理证实为凝血块
1
Alvarez-Laso CJ, Moral S, Rodríguez D, et al. Mucinous adenocarcinoma on perianal fistula. A rising entity?[J]. Clin Transl Oncol, 2018, 20(5): 666-669.
2
Rosser C. The relation of fistula-in-ano to cancer of the anal canal [J]. Trans Am Proc Soc, 1934, 35: 65-71.
3
张恒, 苏丹, 万星阳, 等. 1例肛瘘相关肛周黏液腺癌病例报道并文献回顾 [J]. 结直肠肛门外科, 2020, 26(1): 59-64.
4
刘晓芳, 陈武, 李淳, 等. 超声造影联合实时弹性成像在浅表肿大淋巴结良恶性鉴别诊断中的应用价值 [J]. 中国超声医学杂志, 2019, 35(5): 426-429.
5
Bosman FT, Carneiro F, Hruban RH, et al. Tumours of the anal canal [M]//WHO classification of tumours of the digestive system. IARC: Lyon, 2010: 183-193.
6
Jee SL, Amin-Tai H, Fathi NQ, et al. Perianal mucinous adenocarcinoma diagnosed by histological study of anorectal abscess with fistula[J]. ACG Case Rep J, 2018, 5: e21.
7
Prasad SN, Razik A, Siddiqui F, et al. Mucinous adenocarcinoma arising from chronic perianal fistula mimicking horseshoe abscess [J]. Case Reports, 2018, 2018: bcr-2017-223063.
8
Cenac LA, Xiao P, Asarian A. Incidental discovery of mucinous adenocarcinoma from a suspected inflammatory perianal mass [J]. J Surg Case Rep, 2020, 2020(2): rjz413.
9
Tahir M, Rahman J, Zubair T, Basit A. An association of mucinous adenocarcinoma with chronic peri-anal fistula: a brief review of pathophysiology of rare tumor [J]. Cureus, 2020, 12(6): e8882.
10
Ho CM, Tan CH, Ho BC. Clinics in diagnostic imaging (143). Perianal mucinous adenocarcinoma arising from chronic fistula-in-ano [J]. Singapore Med J, 2012, 53(12): 843-848.
11
Hama Y, Makita K, Yamana T, et al. Mucinous adenocarcinoma arising from fistula in ano: MRI findings [J]. AJR Am J Roentgenol, 2006, 187(2): 517-521.
12
Toyonaga T, Mibu R, Matsuda H, et al. Endoanal ultrasonography of mucinous adenocarcinoma arising from chronic fistula-in-ano: three case reports [J]. J Anus Rectum Colon, 2018, 1(3): 100-105.
[1] 章建全, 程杰, 陈红琼, 闫磊. 采用ACR-TIRADS评估甲状腺消融区的调查研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 966-971.
[2] 罗辉, 方晔. 品管圈在提高甲状腺结节细针穿刺检出率中的应用[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 972-977.
[3] 杨忠, 时敬业, 邓学东, 姜纬, 殷林亮, 潘琦, 梁泓, 马建芳, 王珍奇, 张俊, 董姗姗. 产前超声在胎儿22q11.2 微缺失综合征中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 852-858.
[4] 孙佳丽, 金琳, 沈崔琴, 陈晴晴, 林艳萍, 李朝军, 徐栋. 机器人辅助超声引导下经皮穿刺的体外实验研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 884-889.
[5] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[6] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 563-570.
[7] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 571-579.
[8] 项文静, 徐燕, 茹彤, 郑明明, 顾燕, 戴晨燕, 朱湘玉, 严陈晨. 神经学超声检查在产前诊断胼胝体异常中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 470-476.
[9] 胡可, 鲁蓉. 基于多参数超声特征的中老年女性压力性尿失禁诊断模型研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 477-483.
[10] 张妍, 原韶玲, 史泽洪, 郭馨阳, 牛菁华. 小肾肿瘤超声漏诊原因分析新思路[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 500-504.
[11] 席芬, 张培培, 孝梦甦, 刘真真, 张一休, 张璟, 朱庆莉, 孟华. 乳腺错构瘤的临床与超声影像学特征分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 505-510.
[12] 熊企秋, 邢卉春, 李宝亮, 王杨, 贾哲, 张珂, 黄容海, 蒋力. 人类免疫缺陷病毒感染对肛瘘患者接受切开挂线术治疗预后的影响[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 303-308.
[13] 胡安丽, 黄建, 王建平, 王晓培, 陈宏亮, 陈虹羽. 分期施方熏洗对肛瘘术后患者创面肉芽组织生成的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 402-410.
[14] 张琛, 秦鸣, 董娟, 陈玉龙. 超声检查对儿童肠扭转缺血性改变的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 565-568.
[15] 陈秀晓, 隋文倩, 王珉鑫, 吴圆圆. 腹股沟斜疝并腹腔游离体超声表现一例[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 516-517.
阅读次数
全文


摘要