摘要
目的 探讨前列腺癌临床特点、多参数MRI表现,总结其误诊原因及防范措施。方法 对2020年4月—2022年2月收治的多参数MRI检查后误诊为膀胱癌、前列腺增生的前列腺癌10例的临床资料进行回顾性分析。结果 10例年龄54~73岁。6例因尿急、尿频、尿潴留、排尿困难就诊,直肠指诊示前列腺肥大,查血清前列腺特异性抗原升高,多参数MRI及前列腺穿刺活组织病理检查未发现前列腺肿瘤证据,误诊为前列腺增生,后经术后病理检查确诊T1期前列腺癌。4例以尿痛、血尿、排尿困难就诊,经多参数MRI检查误诊为膀胱癌,查血清前列腺特异性抗原升高,直肠指诊发现前列腺肥大,再次行多参数MRI和前列腺组织穿刺活组织病理检查证实为前列腺癌累及膀胱。误诊时间4~10 d。误诊为前列腺增生6例接受根治性手术,误诊为膀胱癌4例予内分泌和放射治疗,随访至今病情控制尚可。结论 临床接诊以尿急、尿频、尿潴留、排尿困难等症状就诊的中老年男性患者时应考虑到前列腺癌可能。加强对前列腺癌影像学特征认识,行多参数MRI检查时重点观察前列腺结构、包膜完整与否、膀胱壁连续性等重要特征,必要时可行前列腺穿刺活组织病理检查,以提高该病术前诊断正确率。
Objective To investigate the clinical features and multi-parameter MRI findings of prostate cancer,and to summarize the causes of misdiagnosis and preventive measures.Methods The clinical data of 10 patients with prostate cancer misdiagnosed as bladder cancer and prostatic hyperplasia after multi-parameter MRI examination from April 2020 to February 2022 were retrospectively analyzed.Results Ten patients were aged 54-73 years.Six patients presented with urgent urination,frequent urination,urinary retention,and dysuria.Digital rectal examination showed prostate enlargement and elevated prostate-specific antigen in serum.Multi-parameter MRI,prostate biopsy and pathological examination showed no evidence of prostatic tumor,which was misdiagnosed as prostatic hyperplasia.Four patients presented with pain in urine,hematuria,and dysuria.By multi-parameter MRI examination,they were misdiagnosed with bladder cancer.Serum prostate-specific antigen was elevated,digital rectal examination revealed prostate hypertrophy,and multi-parameter MRI and biopsy biopsy of prostate tissue confirmed prostate cancer involving bladder.The duration of misdiagnosis was 4-10 d.Six patients misdiagnosed with prostatic hyperplasia were given radical surgery,and four patients misdiagnosed with bladder cancer were given endocrine and radiation therapy.The condition of ten patients was under control based on follow-up.Conclusion The possibility of prostate cancer should be considered in the clinical treatment of middle-aged and elderly male patients with symptoms such as urgent urination,frequent urination,urinary retention and dysuria.It is necessary to strengthen the understanding of the imaging features of prostate cancer,focus on observing the important features of prostate structure,capsule integrity and bladder wall continuity during multi-parameter MRI,and perform prostate biopsy and pathological exmaination,if necessary,to improve the accuracy of preoperative diagnosis of this disease.
作者
韩磊
桑节峰
孟钢
张虎
李大鹏
HAN Lei;SANG Jiefeng;MENG Gang;ZHANG Hu;LI Dapeng(Department of Imaging,People's Hospital of Ganyu District,Lianyungang,Jiangsu 222100,China;Department of Imaging,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210038,China)
出处
《临床误诊误治》
CAS
2024年第3期21-25,共5页
Clinical Misdiagnosis & Mistherapy
基金
2023年度连云港市科协软课题研究项目(Lkxyb23265)。
关键词
前列腺肿瘤
误诊
膀胱肿瘤
前列腺增生
多参数MRI
直肠指诊
前列腺特异性抗原
病理检查
Prostatic neoplasms
Misdiagnosis
Urinary bladder neoplasms
Prostatic hyperplasia
Multi-parameter MRI
Digital rectal examination
Prostate-specific antigen
Pathological examination
