胃弥漫增厚性病变的临床病理特征及增强CT表现

Clinicopathology and contrast enhancement CT in gastric lesions with diffuse thickened stomach wall

目的探讨胃弥漫增厚型病变的临床病理特点和增强CT表现。方法回顾性分析72例经手术病理证实的胃低中分化腺癌(20例)、粘液腺癌(20例)、印戒细胞癌(20例)和淋巴瘤(12例)。结果90%的胃癌病灶T分期大于等于T3期,85%的胃癌病灶有淋巴结转移,70%的病灶大于等于N2期,75%的病灶总分期大于等于III期。分别有90%、85%和75%的胃低中分化腺癌、粘液腺癌和印戒细胞癌有溃疡存在,淋巴瘤只有25%存在溃疡。大部分粘液腺癌可以看到粘液湖存在。有6例(30%)粘液腺癌伴有钙化。平扫粘液腺癌和淋巴瘤的CT平均值低,分别为34和38HU。胃癌较淋巴瘤强化程度高。结论胃弥漫增厚型肿瘤恶性程度高。粘液湖或钙化是粘液腺癌的重要区分点。增强后黏膜线的显示及病灶强化程度有助于胃癌各亚型与弥漫大B细胞淋巴瘤的区分。

Objective To investigate the clinicopathological features and enhanced CT findings of gastric diffuse thickening lesions.Methods Seventy-two cases of gastric adenocarcinoma(20 cases),mucinous adenocarcinoma(20 cases),signet ring cell carcinoma(20 cases)and lymphoma(12 cases)were analyzed retrospectively.Results The T stages in 90%of gastric cancer lesions are greater than or equal to T3,85%of gastric cancer lesions with lymph node metastasis.The N stages in 70%of the lesions are greater than the N2,75%of the total stages are greater than or equal to III stage.Respectively,90%,85%and 75%of the stomach in the adenocarcinoma,mucinous adenocarcinoma and signet ring cell carcinoma exist ulcers,ulcers can be find in 25%of lymphoma only.Mucous lake Most mucinous can be seen in mucinous adenocarcinoma.Calcification can be seen in six cases(30%)of mucinous adenocarcinoma.The mean CT value of the mucinous adenocarcinoma and lymphoma is 34 and 38 HU,respectively.The contrast enhancement degree of gastric cancer is more intensive than lymphoma.Conclusion The degree of malignancy in gastric lesions with diffuse thickened stomach wall is high.Mucus lake or calcification is an important distinction between mucinous adenocarcinoma and others.Displaying of enhanced mucosal line and enhancement of the degree of gastric cancer contribut to distinction between the subtypes of gastric cancer and diffuse large B cell lymphoma.