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MucinousCarcinomaoftheBreast:MRIFeaturesofPureandMixedFormswithHistopathologicCorrelationShuichiMonzawaetalAJRMarch2009,VOLUME192NUMBER3乳腺粘液腺癌：纯粘液型、混合型粘液腺癌MRI特征与病理的关系杨景震编译Fig.1A—70-year-oldwomanwithpuremucinouscarcinoma.Coronalfat-saturatedT2-weightedMRimageshowshyperintensemass(arrow)withovalshapeandsmoothmargin.Fig.1B—70-year-oldwomanwithpuremucinouscarcinoma.ObliqueaxialearlyphaseMRimageshowsmildheterogeneousenhancementpredominantlyatperipheryofmass(arrow).Fig.1C—70-year-oldwomanwithpuremucinouscarcinoma.CoronaldelayedphaseMRimageshowsstrongheterogeneousenhancementinmass(arrow).Fig.1D—70-year-oldwomanwithpuremucinouscarcinoma.Photomicrographshowsscatteredclustersoftumorcells(grade1cellularity)inmucouslakes.(HandE,×1)纯粘液腺癌ABCDFig.2—58year-oldwomanwithpuremucinouscarcinoma.Coronalfat-saturatedT2-weightedMRimageshowshyperintensemass(arrow)withirregularshapeandirregularmargin.纯粘液腺癌Fig.3A—48-year-oldwomanwithlargepuremucinouscarcinoma.Coronalfat-saturatedT2-weightedMRimageshowshyperintensemass(arrow)withlobulatedshapeandirregularmargin.Darkinternalseptationsappearasisointenselinesinmass.Fig.3B—48-year-oldwomanwithlargepuremucinouscarcinoma.ObliqueaxialearlyphaseMRimageshowsmass(arrow)withstrongheterogeneousenhancementanddarkinternalseptations.Fig.3C—48-year-oldwomanwithlargepuremucinouscarcinoma.SagittaldelayedphaseMRimageshowsmass(arrow)withstrongheterogeneousenhancement.DarkinternalseptationsarelessevidentthaninAandB.巨大纯粘液腺癌MRIFig.3D—48-year-oldwomanwithlargepuremucinouscarcinoma.Photomicrographshowsmarkedproliferationoftumorcellswithmucincollection(grade3cellularity).Thickfibroussepta(arrows)areevidentbetweentumorcellclusters.(HandE,×1)巨大纯粘液腺癌病理图Fig.4A—45-year-oldwomanwithpuremucinouscarcinoma.CoronalearlyphaseMRimageshowsirregularlyshapedmass(arrow)withstrongrimenhancement.Fig.4B—45-year-oldwomanwithpuremucinouscarcinoma.Photomicrographshowsmarkedproliferationoftumorcellsatperipheryandmucouslake(asterisk)interspersedwithsmallclustersoftumorcellsincenterofmass(grade2cellularity).(HandE,×1)纯粘液腺癌Fig.5B—66-year-oldwomanwithmixedmucinouscarcinoma.CoronalearlyphaseMRimageshowsmass(arrow)withstrongheterogeneousenhancement.Fig.5C—66-year-oldwomanwithmixedmucinouscarcinoma.SagittaldelayedphaseMRimageshowsmass(arrow)withstrongheterogeneousenhancement.Fig.5D—66-year-oldwomanwithmixedmucinouscarcinoma.Photomicrographshowsnonmucinouscomponents(N)intermingleddiffuselywithmucinouscomponents(M)(grade1cellularity)throughoutmass.(HandE,×40)Fig.5A—66-year-oldwomanwithmixedmucinouscarcinoma.Coronalfat-saturatedT2-weightedMRimageshowshyperintensemass(arrow)withirregularshapeandirregularmargin.5A5B5C5D混合型粘液腺癌Fig.6C—37-year-oldwomanwithmixedmucinouscarcinoma.Photomicrographshowscomplextumorcomposedofnonmucinouscomponents(N)atperipheryandmucinouscomponents(M)(grade2cellularity)incenterofmass.(HandE,×1)Fig.6A—37-year-oldwomanwithmixedmucinouscarcinoma.Coronalfat-saturatedT2-weightedMRimageshowslobulatedmass(arrow)hyperintenseincenterandisointenseatperiphery.Fig.6B—37-year-oldwomanwithmixedmucinouscarcinoma.CoronalearlyphaseMRimageshowsstrongrimenhancementatperipheryofmass(arrow).Extensiveintraductalcomponent(arrowhead)appearsasfocalorductalenhancementextendingfrommass.混合型粘液腺癌Insummary,boththepureandmixedformsofmucinouscarcinomahadvariousshapes.Puretumorshadasmoothorirregularmargin,butallmixedtumorshadirregularmargins.Thepresenceofveryhighsignalintensityonfat-saturatedT2-weightedimageswasduetotheabundantaccumulationofmucusandwasacommonMRIfeatureinbothforms.Thisfindingmaybeadiagnosticcluesuggestingthepresenceofmucinouscarcinoma.Enhancementpatternduringtheearlyphasevariedwiththecellularityofpuretumorsandwiththedistributionofnonmucinouscomponentsinmixedtumors.HypocellularpuretumorshadatypicalpatternofgradualenhancementandcanbediagnosedcorrectlywithMRI.Hypercellularpuretumorshadstrongearlyenhancementandcanbedifficulttodifferentiatefrommixedtumors.Thepresenceofanareaexhibitingisointensityonfat-saturatedT2-weightedimagesandstrongearlyenhancementimplythepresenceofamixedmucinoustumor.Webelievethisinformationisusefulforthediagnosisandcharacterizationofmucinouscarcinomaofthebreast.研究阻25例，乳腺粘液腺癌分混合型及纯粘液腺癌2种类型。肿瘤形状：纯粘液型光滑或不规则边缘；但所有混合型均为不规则边缘。信号特征：压脂T2WI由于富含粘液蓄积而明显高信号，为两型的普遍特征。增强特点：1、早期强化，随纯粘液型肿瘤细胞的密集度、混合型中非粘液成分的分布而各异。2、细胞密集度低的纯粘液型腺癌具有典型的渐进性强化，据此MR可作出诊断；而细胞密集度高者在增强早期即有明显强化而与混合型鉴别困难。3、T2WI压脂存在等信号区域并增强早期明显强化者则提示为混合型粘液腺癌。动态扫描注意加做延时扫描请看近期本院病例女，65岁。超声检查左侧乳腺肿物粘液腺癌附：对T2WI呈明显囊性特点的病灶影像解读与检查要点男，24岁，左侧锁骨上窝囊性肿物4天而住院，超声检查左侧锁骨上窝囊性肿物；左侧甲状腺低回声结节。行MRI平扫，显示T2WI明显高信号，次日即行手术切除。寻找实性成分，如有即行增强检查观察邻近的淋巴结T2WI延长TE时间；须有DWI评判定性MRI优于CT病理：甲状腺乳头状癌