消化系统和腹膜腔炎性肌纤维母细胞瘤的CT表现与病理对照

CT findings and comparison with pathology of inflammatory myofibroblastic tumor of digestive system and peritoneal cavity

目的探讨消化系统和腹膜腔炎性肌纤维母细胞瘤(IMT)的临床病理特点及CT影像特征,以提高对该病的认识。方法回顾性收集并分析2012年2月至2021年2月郑州大学第一附属医院14例经病理组织学确诊的IMT患者的临床、病理及CT影像资料,观察并评估病灶的部位、形态、生长方式、最长直径、边缘、密度、包膜是否完整、表面有无溃疡,分析病灶增强方式及强化程度等,结合文献分析总结IMT的CT特征并与病理结果相对照。结果14例IMT位于肠系膜3例,胃窦2例,结肠2例,胃体、回肠、回盲部、腹膜后、胆囊、肝脏、胰腺各1例。病灶最长径为2~9(4.90±2.20)cm,6例形态不规则呈分叶状,7例为单发类圆形,1例为多发类圆形;9例有完整包膜,5例包膜不完整;8例瘤内见迂曲血管,11例瘤周见供血血管;12例病灶内见坏死囊变,3例内见钙化,2例内见脂肪,1例合并出血。增强后13例强化不均,7例为全瘤填充样强化,6例为边缘环形强化,1例为中心分隔样强化;9例呈明显强化,4例呈轻度强化,1例呈中度强化。结论IMT可来源于消化道和腹膜腔各区域,临床表现不典型,CT影像表现有一定特征性,对提示IMT的诊断有一定的价值,可辅助临床制定手术方案和治疗后随访,确诊依赖于病理及免疫组织化学检查。

Objective To explore the clinicopathological and CT features of inflammatory myofibroblastic tumor(IMT)of digestive system and peritoneal cavity in order to improve the understanding of the disease.MethodsThe clinical,pathological and CT imaging data of 14 patients with IMT confirmed by histopathology in the First Affiliated Hospital of Zhengzhou University from February 2012 to February 2021 were retrospectively collected and analyzed.The location,shape,growth pattern,longest diameter,edge,density,integrity of capsule,ulcer on the surface,enhancement mode and enhancement degree of the lesions were observed and evaluated.Combined with literature analysis,the CT features of the disease were summarized and compared with the pathological results.ResultsIMT was located in mesentery in 3 cases,antrum in 2 cases,colon in 2 cases,body of stomach,ileum,ileocecal part,retroperitoneum,gallbladder,liver and pancreas in 1 case.The longest diameter of the lesion was 2-9(4.90±2.20)cm,6 cases were irregular and lobulated,7 cases were single round,1 case was multiple round.There were complete capsule in 9 cases and incomplete capsule in 5 cases.Tortuous vessels were found in 8 cases and blood supply vessels were found around the tumor in 11 cases.Necrosis and cystic degeneration were found in 12 cases,calcification in 3 cases,fat in 2 cases and hemorrhage in 1 case.After contrast-enhanced,13 cases showed uneven enhancement,7 cases showed whole tumor filling enhancement,6 cases showed edge ring enhancement,and 1 case showed central septal enhancement.Nine cases showed obvious enhancement,4 cases showed mild enhancement and 1 case showed moderate enhancement.ConclusionIMT can come from various regions of digestive tract and peritoneal cavity,and its clinical manifestations are not typical.CT images have certain characteristics,which has certain value in the diagnosis of IMT.It can assist in the clinical planning of operation and follow-up after treatment,but the diagnosis depends on pathological and immunohistochemical examination.