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(Department of Ultrasound, the First Affiliated Hospital ofFujian Medical University， Fuzhou 350005， China)



Comparative analysis of ultrasonographic and pathologic findings of uterine lipoleiomyoma

YEXiaojian,XURongquan*,YANLei,XUXiang,CHENXiaoyu

(DepartmentofUltrasound,theFirstAffiliatedHospitalofFujianMedicalUniversity，Fuzhou350005，China)

Objective To explore the ultrasound characteristics of uterine lipoleiomyoma. Methods The clinical and ultrasound data of 21 patients with lipoleiomyoma confirmed by surgical pathology were retrospectively analyzed. The level of adipose cells in pathological images were determined by the automatic image analysis software (Image-Pro Plus). And the ultrasound features and the pathology performance were comparatively analyzed. Results There were 25 tumors in 21 patients with uterine lipoleiomyoma， included 17 lesions located in uterine corpus， 5 lesions in uterine submucosa， 2 lesions in uterine subserosa, 1 lesion in cervix. The dense high echoes were found in 13 lesions. And the mixed echoes of high and low were found in 9 lesions. The hypoechoes were found in the other 3 lesions. According to Adler's semi quantitative method， the tumors blood flows were manifested as grade 0 of 8 lesions， grade Ⅰ of 13 lesions， grsde Ⅱ of 3 lesions and grade Ⅲ of 1 lesion. The content of adipose cell was 10%—95% in the tumor. The adipose cells distributed alternately with the smooth muscle cells, in the forms of dot, cluster and sheet. Conclusion The uterine lipoleiomyoma has characteristic ultrasonographic performance of dense hyper echo，which points out that the content of adipose cells is higher in pathological tissue.

Uterus； Leiomyoma； Ultrasonography； Pathology

子宫脂肪平滑肌瘤是一种良性子宫肿瘤，属子宫平滑肌瘤的特殊亚型，瘤体由成熟的脂肪细胞及平滑肌细胞混杂构成，患者常无特异性症状或体征。临床常因本病罕见及超声医师对其认识不足而造成误、漏诊。本研究回顾性分析21例子宫脂肪平滑肌瘤患者的声像图表现，并与病理对照，以期提高对本病的超声诊断能力。

1 资料与方法

1.1一般资料 回顾性分析2007年1月—2014年6月于我院接受超声检查后经手术经病理证实为子宫脂肪平滑肌瘤的患者共21例，年龄43～73岁，中位年龄55岁。21例均为已婚；2例未育；18例处绝经期。就诊原因包括：体检偶然发现13例，阴道不规则出血或月经量增多3例，腹部包块5例。

1.2超声检查 采用Philips iU22彩色超声诊断仪，C5-1腹部探头，频率1～5 MHz；Siemens Sequoia 512彩色超声诊断仪，4C1腹部探头，频率2.0～4.5 MHz。对21例均行经腹超声检查，对其中2例结合经阴道超声检查。常规多切面扫查子宫及双侧附件区，观察瘤体位置、形态、大小、包膜、内部回声及分布。以CDFI及频谱多普勒观察肿瘤内部及周边彩色血流信号及分布情况，并进行Adler血流半定量分级。

1.3病理检查 对所有患者均于超声检查后2周内行外科手术治疗，并进行术后病理检查。应用全自动图像分析软件(Image-Pro Plus)评估病理组织中脂肪细胞的含量。

2 结果

21例患者的临床资料、声像图特征、病理组织中脂肪细胞含量及并发症情况见表1。

2.1超声表现 21例患者术前超声检查声像图表现为单发肿瘤17例，多发肿瘤4例；共25个病灶，其中17个位于子宫体肌壁间(17/25，68.00%)，5个位于浆膜下(5/25，20.00%)，2个位于黏膜下(2/25,8.00%)，1个位于宫颈部(1/25，4.00%)；……