儿童结肠炎性肌纤维母细胞瘤伴肠梗阻1例并文献复习  

Gastrointestinal inflammatory myofibroblastic tumor with intestinal obstruction in children:a case report and literature review

作　　者：董璐 闫喆[1] 王春祥[1] DONG Lu;YAN Zhe;WANG Chunxiang(Department of Radiology,Tianjin Children’s Hospital(Children’s Hospital of Tianjin University),Tianjin 300134,China)

机构地区：[1]天津市儿童医院(天津大学儿童医院)影像科,天津300134

出　　处：《国际医学放射学杂志》2021年第3期346-350,共5页International Journal of Medical Radiology

摘　　要：目的探讨儿童胃肠道炎性肌纤维母细胞瘤(IMT)的影像学特征及鉴别诊断。方法回顾性分析1例儿童结肠IMT伴肠梗阻的平扫和增强CT表现及临床病理学特征,并复习相关文献。结果腹部平扫CT显示左中腹部结肠脾曲可见不规则分叶状软组织密度肿块影,突破肠壁黏膜层向腔内生长,并占据整个肠腔,邻近肠管管壁增厚,周围脂肪间隙密度增高,横结肠及右半结肠可见明显积粪和扩张。增强后肿块呈“持续渐进性强化”,伴邻近肠壁强化较均匀的小结节样突起。能谱散点图显示肿块与小突起的碘浓度接近,动脉期、静脉期、延迟期能谱曲线呈依次升高趋势,且延迟期4个兴趣区(ROI)的能谱曲线趋一致。病理诊断为IMT。结论儿童胃肠道IMT罕见,多发病灶者更为罕见,其影像学表现缺乏特异性,确诊仍依赖于病理及免疫组化检查。Objective To explore the imaging characteristics and differential diagnosis of gastrointestinal inflammatory myofibroblastic tumor(IMT)in children.Methods The plain and enhanced CT findings and clinicopathological features of a child with gastrointestinal IMT were analyzed retrospectively,and the relevant literatures were reviewed.Result The plain abdominal CT showed an irregularly lobulated soft tissue mass in the colon splenic flexure of the left middle abdomen,breaking through the mucus layer of the intestinal wall and growing into the lumen.The whole intestinal cavity was occupied.Adjacent intestinal wall was thickened and the density of surrounding fat space increased.The transverse and right-semi colon showed significant dilatation and pnuematosis.The mass showed“continuous progressive enhancement”on enhanced CT,accompanied by small nodular lesion with even enhancement in the adjacent intestinal wall,and the energy scatter diagram showed the mass and the nodules had similar iodine concentration.The energy spectrum curves of arterial,venous,and delay phases showed a successively increasing trend,and the energy spectrum curves measured from four regions of interest in the delay phase kept consistent.Pathologic diagnosis was IMT.Conclusion IMT of gastrointestinal tract in children is rare and multifocal lesions are even more rare.The imaging findings are non-specific.The final diagnosis depends on pathological and immunohistochemical examination.

关 键 词：儿童 青少年 胃肠道 炎性肌纤维母细胞瘤 体层摄影术 X线计算机 

分 类 号：R725.8[医药卫生—儿科] R445.3[医药卫生—临床医学]