以肠套叠为首发症状的5例儿童腹部淋巴瘤临床及影像特点

Clinical and Imaging Features of Abdominal Lymphoma in 5 ChildrenInitially Manifested as Intussusception

目的总结分析以肠套叠为首发症状的5例儿童腹部淋巴瘤的临床及影像特点。方法回顾性总结分析郑州大学第三附属医院2014年8月至2020年8月诊治的首发症状为肠套叠并经术后病理证实为淋巴瘤的5例患儿的临床信息、诊断性空气灌肠复位特点及CT特点。结果5例以肠套叠为首发症状的腹部淋巴瘤患儿中,位置位于回肠末端者3例(60%),位于回盲部及升结肠者各1例(20%)。其中4例(80%)行空气灌肠复位治疗失败,1例(20%)短期内反复出现肠套叠,复位后回盲部均可见软组织包块,急诊手术探查切除局部病灶。术后病理提示,Burkitt淋巴瘤者3例(60%),弥漫性大B细胞淋巴瘤者2例(40%),其中1例Burkitt淋巴瘤患儿可见肝多发转移结节。5例患儿均在病理明确诊断及分期后接受规范化疗。结论以肠套叠为首发症状的腹部淋巴瘤,有一定的临床及影像特点,临床表现为大龄儿童、反复发作或空气灌肠整复失败肠套叠,影像上常表现为均匀轻中度强化肠壁肿块。

Objective To summarize and analyze the clinical and imaging characteristics of abdominal lymphoma in 5 children initially manifested as intussusception.Methods The clinical information,air enema reduction features and CT features of abdominal lymphoma in 5 children with intussusception as the first symptom and lymphoma confirmed by postoperative pathology in the Third Affiliated Hospital of Zhengzhou University from August 2014 to August 2020 were retrospectively summarized and analyzed.Results Of the 5 cases,3 cases(60%)of intussusception were located at the terminal ileum,and 1 case(20%)was located at the ileocolic area,and 1 case(20%)was located at the ascending colon,respectively.Four cases(80%)failed after air enema reduction.One case(20%)had recurrent intussusception within a short period of time,and a soft tissue mass was found in the ileocecal area after a successful enema reduction,and emergent surgical abdomen exploration and local lesion excision were then performed.Postoperative pathological results showed that there were 3 cases(60%)of Burkitt lymphoma and 2 cases(40%)of diffuse large B cell lymphoma.One case of Burkitt lymphoma was found with multiple liver metastases.All patients received standardized chemotherapy after the definite pathological diagnosis and staging.Conclusion Abdominal lymphoma with intussusception as the first symptom has certain clinical and imaging characteristics.Its clinical manifestations include intussusception in older children,repeated attacks or failure of air enteroplasty,and its imaging manifestations are usually uniform mild to moderate enhancement of intestinal wall mass.