小肠间质瘤的超声表现及病理特征

Comparative analysis between the ultrasonic picture and pathology of small intestinal stromal tumors

目的探讨小肠间质瘤的超声表现和病理特征,评价超声在其诊断及治疗中的价值。方法回顾性分析经病理及免疫组化证实的23例小肠间质瘤患者的影像学资料,并与临床病理相对照。结果23例患者中,2例为良性。21例为恶性,其中5例为低度恶性,16例为高度恶性。肿瘤最大15cm×11cm×8cm,最小4cm×2cm×3cm,超声表现为圆形、椭圆形或分叶状,以腔外生长为主,内部回声不均匀,可见坏死及囊性变,彩色和频谱多普勒显示其内血供丰富。病理学检查示恶性肿瘤瘤体质硬,血管丰富,肿瘤内有出血、坏死,免疫组化染色CD117均呈阳性。结论小肠间质瘤缺乏特征性临床表现,超声检查是临床首选且重要的影像学检查方法。其最终确诊依赖病理及免疫组织化学检查。

Objective To investigate the features of the ultrasonic picture and pathology of small intestinal stromal tumors, and evaluate the value of ultrasonography in diagnosis and during treatment of small intestinal stromal tumors. Methods The ultrasonic examination results were reviewed and analyzed in 23 patients with small intestinal stromal tumors which were diagnosed pathologically and immunohistochemieally, and then correlated the pictures with the results of pathological examination. Results The 23 small intestinal stromal tumors being investigated included 2 benign small intestinal stromal tumors and 21 malignant small intestinal stromal tumors. Among the malignant tumors 5 were low graded and 16 high graded. The ultrasonic examinations showed that the size of the largest tumor was 15cm ×11cm×8cm, and that of the smallest tumor was 4cm×2cm×3cm. The small intestinal stromal tumors were mainly extraluminal, and were in round, oval or lobular shape, the nonternal echo was nonhomogeneous, with signals denoting necrosis and cystic change. The color Doppler flow imaging and spectral Doppler imaging results showed that the tumors were rich in blood supply. The pathological examinations showed that the malignant tumors were hard, and rich in blood vessels, with hemorrhage and necrosis within tumors, and was CD117 positive as revealed by immunohistoehemical examination. Conclusions Small intestinal stromal tumors lack specific clinical manifestations. Clinically, ultrasonography is a first choice and important image examination for small intestinal stromal tumors. The final diagnosis of small intestinal stromal tumor depends on pathologic and immunohistochemical examinations.