腹腔反应性结节状纤维性假瘤一例并文献回顾

Reactive nodular fibrous pseudotumor of abdominal cavity: a case report and review of literature

目的分析腹腔反应性结节状纤维性假瘤(Reactive nodular fibrous pseudotumor,RNFP)的影像特征,提高对该病的认识和术前诊断,防止临床上的过度医疗。方法搜索了MEDLINE、EMBASE、WebofScience、中国知网、万方医学网的多个中英文数据库,获得关于腹腔反应性结节状纤维性假瘤的病例报道,总结相应临床、影像、病理等特征。结果11例(35.5%)患者有明确手术史,10例(32.3%)中提及有较明显腹部疾病史。单发17例(54.8%),多发10例(32.3%)。最常见病变的是结肠与阑尾(10例),其次是肠系膜和小肠尤其是回肠末端(9例),网膜(5例),腹膜壁(4例),肝囊、胃壁和胰周(分别有1、2、1例);部分RNFP可向胃、肠壁浸润并溃疡或肠瘘形成(9例),部分病例病灶侵犯胰体和尾部,脾脏和左肾上腺(1例)。该病的影像表现与疾病的病理特征即肿瘤镜下表现为杂乱排列的星状或梭形细胞,境界清楚,伴黏液变性或玻璃样变性,可见瘢痕疙瘩样粗大胶原纤维。结论RNFP考虑为一种罕见的、由腹、盆腔手术或炎症刺激所致的腹腔纤维性炎性病变,由于没有特异性的影像表现,易与卵巢来源疾病相混淆,病理及免疫组化是诊断金标准。手术是首选治疗方法。

Objective To analyze the imaging features of Reactive nodular fibrous pseudotumor (RNFP), to improve the understanding and preoperative diagnosis of the disease, and to prevent clinical over-medication. Methods A number of databases such as MEDLINE, EMBASE, Web of Science, China Knowledge Network, and Wanfang Medical Network were searched to obtain cases of abdominal reactive nodular fibroids, and the corresponding clinical, imaging, and pathological features were summarized. Results 11 patients (35.5%) had a clear history of surgery, and 10 patients (32.3%) mentioned a more obvious history of abdominal disease.17 cases were single (54.8%) and 10 cases were multiple (32.3%).The most common lesions were the colon and appendix (10 cases), followed by the mesentery and small intestine, especially the terminal ileum (9 cases), omentum (5 cases), peritoneal wall (4 cases), hepatic sac, stomach wall and pancreatic circumference. Some RNFP can infiltrate the stomach and intestinal wall and ulcer or intestinal fistula formation (9 cases), some cases of lesions invade the pancreas and tail, spleen and left adrenal gland (1 case).The imaging manifestations of the disease and the pathological features of the disease, that is, the tumors appear as a disorderly arrangement of stellate or fusiform cells, with clear boundaries, with mucoid degeneration or hyaline degeneration, showing that keloid-like coarse collagen fibers are closely related. Conclusion RNFP is considered to be a rare abdominal fibrotic inflammatory lesion caused by abdominal, pelvic surgery or inflammatory stimuli. Because there is no specific imaging manifestation, it is easy to be confused with ovarian-derived diseases. Pathology and immunohistochemistry are diagnoses, gold standard. Surgery is the first choice of treatment.