CT及MRI在诊断小肠原发尤文肉瘤/原始神经外胚层肿瘤中的价值一例并文献回顾  

Application Value of CT and MRI in Diagnosis of Ewing's Sarcoma/Primitive Neuroectodermal Tumor: A Case Report and Literature Review

作　　者：韩旭[1,2] 张挽时[3] 孙美玉[2] HAN Xu;ZHANG Wan-shi;SUN Mei-yu(Department of Graduate School, Dalian Medical University, Dalian Liaoning 116044,China;Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian Liaoning 116011, China;Department of MRI, Air Force General Hospital, Beijing 100142, China)

机构地区：[1]大连医科大学研究生院,辽宁大连116044 [2]大连医科大学附属第一医院放射科,辽宁大连116011 [3]空军总医院磁共振科,北京市100142

出　　处：《中国医疗设备》2017年第5期80-83,共4页China Medical Devices

摘　　要：目的探讨小肠原发尤文肉瘤/原始神经外胚层肿瘤[(Ewing’S Sarcoma,ES)/(Primitive Neurotodermal Tumour,PNET)]的CT、MRI特征诊断及鉴别诊断。方法对1例小肠ES/PNET患者的CT、MRI影像表现结合病理及免疫组化进行分析,并回顾相关文献。结果患者女性,15岁,贫血两年,间断便血1月余。CT示右下腹小肠肿块,密度不均;增强病灶实性成分不均匀强化。MRI示肿块呈等长T1、T2信号,增强特点与CT相同。病理示浆膜层小圆细胞恶性肿瘤伴出血囊变,肿瘤细胞呈弥漫及巢状排列,血窦丰富;免疫组化分化抗原99(CD99)(++)、波形蛋白(VIM)(+)、突触素(Syn)(+)、上皮膜抗原(EMA)(弱+)、孕激素受体(PR)(+)、人角蛋白抗原决定簇5.2(CAM5.2)(弱+)。结论小肠ES/PNET是一种罕见小圆细胞恶性肿瘤,CT、MRI表现无特异性,但可以准确定位和描述肿瘤的大小、形态、密度,明确其恶性征象及有无远处转移,为术前诊断及手术方案制定提供大量重要信息。Objective To investigate CT and MRI features,diagnosis and antidiastole of Ewing's Sarcoma/primitive neuroectodermal tumor(ES/PNET)in small intestine.Methods Analysis CT and MR imaging feature,with pathology and immunohistochemistry of1case of small intestinal ES/PNET patient and review of the literature.Results A15-year-old female patient with two-year history anemia and intermittent hematochezia for1month.CT scan revealed the presence of a large soft tissue mass in right lower abdomen,the mass was heterogeneous.A contrast enhanced CT scan demonstrated that the solid components of the mass were obvious enhanced.The MRI scan revealed that a heterogeneous mass arose in right lower abdomen-vesicouterine pouch,which presented isointensity on both T1-weight image and T2-weight images.The enhancement pattern of the mass was similar in MRI with that of CT scans.The pathology diagnosis was altered to intestine malignant small round cell tumor with blood sinus,areas of hemorrhage and cyst formation can be seen,the cells were diffuse and arranged in nests.Immunohistochemical tests were performed,the results were as follows:positive expression for CD99,VIM,Syn,EMA,PR and CAM5.2.Conclusion Small intestine ES/PNET is a rare small round and highgrade cell malignant tumors.The imaging feature are non-specific in CT and MRI,but the mass can belocated accurately and described the size,shape and density.It also can confirm the signs of malignancy and whether there is a distant metastasis.It provides a great deal of valuable information for preoperative diagnosis and surgical planning.

关 键 词：CT MRI 小肠 尤文肉瘤/原始神经外胚层肿瘤 免疫组化 

分 类 号：R734.2[医药卫生—肿瘤] R445.4[医药卫生—临床医学]