【病例】小肠淋巴瘤VS胃肠道间质瘤各1例影像鉴别分析

7 9月

周建收(焦作91医院)

Hello everyone. Today it’s my turn to discuss the case with us.it’s 8.00 pm now,let’s begin.

History: A 53-year-old man presents for evaluation of increasing abdominal distention.53岁男性,腹部进行性膨隆进行评估。

Axial and coronal contrast-enhanced CT images of the abdomen.

【病例】小肠淋巴瘤VS胃肠道间质瘤各1例影像鉴别分析

【病例】小肠淋巴瘤VS胃肠道间质瘤各1例影像鉴别分析

周建收:1.What is the salient finding?A. Small-bowel obstructionB. Perforation of the small bowel

C. Aneurysmal dilatation of the small bowel

D. Enteroenteric intussusception

E. Intramural small-bowel hematoma

周建收:someone here?

余水莲(管理员广西省医):yeah!D?

陈富星(宁波北仑人民医院):C

周建收:最明显的发现为?

A.小肠梗阻

B.小肠穿孔

C.小肠动脉瘤样扩张

D.肠套叠

E.小肠壁内血肿

高回青:C

周建收:The correct answer is C.

余水莲:yeah C

周建收:Additional coronal CT image

【病例】小肠淋巴瘤VS胃肠道间质瘤各1例影像鉴别分析

周建收:2.What additional finding is demonstrated?A. Evidence of osseous metastatic diseaseB. Retroperitoneal lymphadenopathy

C. Multiple abscesses

D. Meckel’s diverticulum

余水莲:B

高回青:B

周建收:Yes

程祖胜(浙江绍兴七院精神心理科):B

周建收:所示额外的发现为?

A.骨转移瘤证据

B.腹膜后淋巴结肿大

C.多发脓肿

D. Meckel’s憩室

              The correct answer is B.

张福来(四平中心医院):B

周建收:Nuclear medicine images

【病例】小肠淋巴瘤VS胃肠道间质瘤各1例影像鉴别分析

【病例】小肠淋巴瘤VS胃肠道间质瘤各1例影像鉴别分析

孙昊(北京协和医院放射科):typical primary GI lymphoma周建收:3.What is the most likely diagnosis?A. Small-bowel lymphoma

B. Small-bowel adenocarcinoma

C. Crohn\’s disease

D. Celiac disease

余水莲:A

程祖胜:A

周建收:最可能的诊断为?

A.小肠淋巴瘤

B.小肠腺癌

C.克隆氏病

D.乳糜泻

The correct answer is A.

周建收:4. Bowel obstruction is common with this entity.

True

False

余水莲:F

程祖胜:F

周建收:really? is it too simple?

The correct answer is False.

              another case

【病例】小肠淋巴瘤VS胃肠道间质瘤各1例影像鉴别分析

周建收:What is the most likely diagnosis?A. Small-bowel lymphomaB. Small-bowel adenocarcinoma

C. Crohn\’s disease

D. Celiac disease

余水莲:A?

程祖胜:D?

高回青:这个粘膜有破坏,还造瘘,说明有梗阻。

余水莲:是疝?

周建收:造瘘是以前手术所致

高回青:但粘膜是破坏了

周建收:history:familial adenomatous polyposis

Small bowel adenocarcinoma in familial adenomatous                               polyposis小肠腺癌并家族性腺瘤性息肉病

余水莲:家族性腺瘤息肉病

周建收:The yellow arrows point to an annular lesion surrounding an irregular collection of contrast, the ulcerated center of a large necrotic tumor. Note that there is no distention of small bowel. Oral contrast has reached the stoma. While this could represent a lymphoma, the history and absence of mesenteric or retroperitoneal lymphadenopathy make adenocarcinoma the most likely diagnosis.

余水莲:肠管没变窄

周建收:Large adenocarcinomas and lymphomas can have similar imaging appearances

周建收:Lymphomas make up about 20 % of all small bowel tumors.The distal ileum is the most common site, owing to the large amount of lymphoid tissue that is present in the distal ileum.Risk factors include celiac disease, Crohn\’s disease, SLE, immunocompromised state and a history of chemotherapy or extra-intestinal lymphoma.

The typical presentation of a small bowel lymphoma is a thick walled infiltrating mass with aneurysmal dilatation without obstruction.

Aneurysmal dilatation is based upon destruction of the bowel wall and the myenteric nerve plexus.

A less common presentation is as an intraluminal polypoid mass or a large excentric mass with extension into the surrounding soft tissues with possible ulceration and formation of fistulas.

余水莲:wow

周建收:淋巴瘤约占所有小肠肿瘤的20 %。

回肠末端为最常见部位,因为有大量淋巴组织位于回肠末端。

危险因素包括乳糜泻,克隆氏病,系统性红斑狼疮(SLE),免疫功能不全,化疗病史或肠外淋巴瘤。

小肠淋巴瘤的典型表现为壁增厚的浸润性肿块,呈动脉瘤样扩张但无梗阻。

动脉瘤样扩张是基于肠壁和肠肌间神经丛的破坏。

少见表现为肠腔内息肉样肿块或较大偏心性肿块并蔓延进入周围软组织,可伴溃疡或形成瘘道。

周建收:Differential diagnosis

1. Small bowel adenocarcinoma

Large adenocarcinomas and lymphomas can have similar imaging appearances.

Bulky mesenteric or retroperitoneal lymphadenopathy and splenomegaly are findings that support the diagnosis of a lymphoma.

Infiltration of the mesenteric fat favours the diagnosis of an adenocarcinoma.

周建收:较大腺癌和淋巴瘤可有相似的影像学表现。

体积较大的肠系膜或腹膜后肿大淋巴结及脾大是支持诊断淋巴瘤的征象。

肠系膜脂肪浸润则支持腺癌的诊断

【病例】小肠淋巴瘤VS胃肠道间质瘤各1例影像鉴别分析周建收:黄箭示环形病变包绕不规则对比剂,内见大的中心坏死并溃疡形成。注意小肠无扩张。对比剂进入造瘘口(红箭)。虽然此表现也可为淋巴瘤,但考虑患者病史(家族性腺瘤性息肉病)并且无肠系膜或腹膜后肿大淋巴结,故腺癌为最可能的诊断。高回青:yeah

周建收:2. GIST

Both GIST and lymphoma can show aneurysmal dilation of the bowel.

Lymph node metastases are generally not seen in GIST.

If lymphadenopathy is seen, you should consider another diagnosis.

周建收:胃肠道间质瘤和淋巴瘤均可使肠管呈动脉瘤样扩张。

胃肠道间质瘤一般无淋巴结转移。

如果发现淋巴结肿大,则不应考虑GIST。

余水莲:Yes

周建收:所以说动脉瘤样扩张并非淋巴瘤的特异性征象,必须结合病史和影像学表现综合考虑。

余水莲:thx,learned a lot@焦作91医院 周建收

周建收:That’ all. Thank you!

余水莲:很好的对比学习,谢谢周老师精心准备

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