An 85-year-old woman with a history of ruptured abdominal aortic aneurysm (AAA) status post surgical repair now presents with an enlarging abdominal mass and sharp pain. The patient is hemodynamically stable, but labs are notable for severe anemia. 85岁女性,腹主动脉瘤破裂修复术后。发现腹部包块逐渐增大伴锐痛。患者现血流动力学情况稳定,但有严重的贫血。 1、There is recurrent rupture of the repaired aortic aneurysm 腹主动脉瘤修复术后复发破裂 True False 2、There is a heterogeneous retroperitoneal mass 腹膜后不均质肿块 True False 3、There is left-sided hydronephrosis 左肾积水 True False 4、Which of the following is the best next step? 下一步最好采取什么措施? Ultrasound-guided drain placement for complex collection 超声引导下穿刺引流 Emergent laparotomy for repair of recurrent ruptured AAA 急诊剖腹手术修复破裂的腹主动脉瘤 Emergent angiography and endovascular aneurysm repair (EVAR) for recurrent ruptured AAA 急诊动脉造影术及腹主动脉瘤破裂血管腔内修复术 MRI for further characterization of the mass MRI对肿块进一步定性 MRI is attained for further characterization of the left abdominal mass. 患者行MRI检查以进一步对左腹部包块定性。 In order: T2, T1 postgadolinium, and two T2 images. 5、The mass is predominantly T2 hyperintense. 肿块以T2WI高信号为主 True False 6、There are enhancing septae within the mass. 肿块内可见强化的分隔 True False 7、Which of the following is the most likely diagnosis? 下列最有可能的诊断是什么? Gastrointestinal stromal tumor 胃肠道间质瘤GIST Retroperitoneal sarcoma 腹膜后肉瘤 Angiomyolipoma 血管平滑肌脂肪瘤AML Infected aortic aneurysm graft 主动脉瘤移植片感染 Lymphoma 淋巴瘤 8、Which of the following is the most common retroperitoneal sarcoma? 腹膜后肿瘤最常见的是下列哪种? Liposarcoma 脂肪肉瘤 Leiomyosarcoma 平滑肌肉瘤 Fibrosarcoma 纤维肉瘤 Rhabdomyosarcoma 横纹肌肉瘤 9、MRI features are sufficient to distinguish between sarcoma subtypes and, therefore, biospy is typically not required. 该病的MRI征象已经非常明确,足以区分肉瘤的亚型,通常不需要活检。 True False 10、The patient underwent surgical debulking, and surgical pathology confirmed high-grade leiomyosarcoma. Which vascular structure is most often involved in retroperitoneal leiomyosarcoma? 该患者行外科减瘤术,手术病理证实为高级别平滑肌肉瘤。腹膜后平滑肌肉瘤最易累及下列哪个器官? Aorta Inferior vena cava (IVC) Left renal vein Superior mesenteric artery 选择题答案:
Retroperitoneal sarcoma (leiomyosarcoma) 腹膜后平滑肌肉瘤 Malignancy of mesodermal origin that arises from smooth muscle cells of vasculature or bowel. 起源于中胚层的恶性肿瘤,多发生于脉管系统或肠道的平滑肌细胞。
Imaging features are nonspecific, and biopsy is usually required for a diagnosis. 影像表现缺乏特异性,定性诊断需要依靠病理活检。 Large retroperitoneal mass, often 10 cm or larger at diagnosis. 腹膜后巨大肿块,发现时常超过10cm。 Imaging findings are nonspecific and vary depending on tumor composition. 影像学表现缺乏特异性,根据肿瘤成分不同,表现也不同:
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