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Lymphoma and Stromal Tumor of the Small Intestine: Ultrasound Findings and Differential Diagnosis
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摘要:
目的 探讨超声对小肠淋巴瘤与小肠间质瘤的诊断与鉴别诊断价值。 方法 回顾性分析2009年1月至2016年1月于中国医学科学院肿瘤医院就诊, 行超声检查并经病理证实的36例小肠淋巴瘤和69例小肠间质瘤患者资料, 分析比较其临床特征和超声征象。 结果 小肠淋巴瘤和小肠间质瘤在超声回声是否均匀、是否伴有无回声区、是否伴有气体回声以及超声分型方面差异存在统计学意义(P均 < 0.001), 而在临床特征、大小、边界、是否分叶等方面差异无统计学意义。小肠淋巴瘤多表现为回声均匀、病灶内部无囊变坏死区, 超声分型为浸润型和肿块型; 而小肠间质瘤多表现为回声不均匀, 病灶内部可见囊变坏死区, 超声分型均为肿块型。 结论 小肠淋巴瘤和小肠间质瘤的超声征象具有特征性表现并有一定差异, 有助于对两者进行诊断和鉴别诊断。 Abstract:Objective To investigate the value of ultrasonography in the diagnosis and differential diagnosis of lymphoma and stromal tumor of the small intestine. Methods The clinical characteristics and ultrasound findings of 36 patients with small intestine lymphoma and 69 patients with small intestine stromal tumor confirmed pathologically in Cancer Hospital of Chinese Academy of Medical Sciences between January 2009 and January 2016 were retrospectively analyzed and compared. Results There were statistically significant differences in echotexture, presence of echoless area, intratumoral gas, and ultrasonographic pattern between small intestine lymphoma and small intestine stromal tumor (all P < 0.001), whereas no statistically significant difference in clinical characteristics, lesion size, contour, or lobulated mass. On ultrasound, small intestine lymphoma mainlydemonstrated as infiltrative or mass-forming type, with homogeneous echotexture without cystic necrotic area; while small intestine stromal tumor demonstrated as mass-forming type with heterogeneous echotexture and cystic necrotic area. Conclusions Lymphoma and stromal tumor of the small intestine both have some characteristic ultrasound features, the difference between which may help in the diagnosis and differential diagnosis of these two conditions. -
图 1 男性，53岁，左上腹见小肠壁全周增厚，呈均匀低回声，中心可见气体回声(箭头), 病灶最大径约13 cm；超声引导下粗针穿刺活检病理证实为黏膜相关淋巴组织结外边缘区B细胞淋巴瘤
表 1 2015年北京协和医院分离的粪肠球菌和屎肠球菌对抗菌药物的耐药率和敏感率(%)
项目 小肠淋巴瘤
(n=36)小肠间质瘤
(n=69)P值 临床特征 年龄(x±s，岁) 54.9±15.1 55.3±10.6 0.865 性别(男/女，例) 24/12 42/27 0.672 肿瘤大小(x±s，cm) 10.2±3.2 10.8±6.1 0.559 超声特征(例) 回声 ＜0.001 均匀 24 11 不均匀 12 58 边界 0.062 清 22 54 不清 14 15 分叶 0.050 无 12 11 有 24 58 无回声区 ＜0.001 有 5 53 无 31 16 气体回声 ＜0.001 有 29 14 无 7 55 超声分型 浸润型 11 0 ＜0.001 肿块型 25 69 
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[1] Korman MU.Radiologic evaluation and staging of small intestine neoplasms[J].Eur J Radiol, 2002, 42:193-205. doi: 10.1016/S0720-048X(02)00034-7 [2] Wan DS, Wu XJ, Pan ZZ, et al. Imatinib mesylate in the treatment of advanced gastrointestinal stromal tumors[J].Zhonghua Yi Xue Za Zhi, 2006, 86:3064-3067. http://www.ncbi.nlm.nih.gov/pubmed/17288838 [3] Fujita M, Manabe N, Honda K, et al. Usefulness of ultrasonography for diagnosis of small bowel tumors:a comparison between ultrasonography and endoscopic modalities[J].Medicine (Baltimore), 2015, 94:e1464. http://pubmedcentralcanada.ca/pmcc/articles/PMC4616743/ [4] Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma[J]. World J Gastroenterol, 2011, 17:697-707. doi: 10.3748/wjg.v17.i6.697 [5] Burke JS. Lymphoproliferative disorders of the gastrointestinal tract:a review and pragmatic guide to diagnosis[J]. Arch Pathol Lab Med, 2011, 135:1283-1297. doi: 10.5858/arpa.2011-0145-RA [6] Fernandes DD, Galwa RP, Fasih N, et al. Cross-sectional imaging of small bowel malignancies[J]. Can Assoc Radiol J, 2012, 63:215-221. doi: 10.1016/j.carj.2010.10.001 [7] Miettinen M, Lasota J. Gastrointestinal stromal tumors:review on morphology, molecular pathology, prognosis, and differential diagnosis[J].Arch Pathol Lab Med, 2006, 130:1466-1478. http://www.tandfonline.com/servlet/linkout?suffix=CIT0002&dbid=8&doi=10.1586%2Fera.12.86&key=17090188 [8] Wronski M, Cebulski W, Slodkowski M, et al. Gastrointestinal stromal tumors:ultrasonographic spectrum of the disease[J].J Ultrasound Med, 2009, 28:941-948. doi: 10.7863/jum.2009.28.7.941 -
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