临床研究(Clinical Research)

脾炎性肌纤维母细胞瘤的诊断与治疗:附72 例报告并文献复习

Published at: 2015年第24卷第8期

李明信 1 , 陈育洪 1 , 朱贤胜 2 , 陈晓东 3 , 廖秋林 2 , 马建青 1
1 广州军区广州总医院华侨外科,广东 广州510010
2 广州军区广州总医院超声影像科,广东 广州510010
3 广州军区广州总医院病理科,广东 广州510010
通讯作者 明信 李 Email: lmxhsj@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.08.021
基金:

摘要

目的:探讨脾炎性肌纤维母细胞瘤(SIMT)的临床病理特征、诊断与治疗。方法:收集广州军区广州总医院收治的4 例与文献报道68 例SIMT 患者的临床资料,分析和总结患者主要临床表现、影像学特征、病理学诊断依据、治疗方法及疗效。结果:患者多为成年男性,大部分以左上腹痛为首发主要症状,常伴有发热、乏力、消瘦、贫血等全身症状,影像学检查示绝大部分为单发、边界多清楚的局限性包块。B 超检查为脾内不均匀回声包块,彩色多普勒血流显像示肿块乏血供或少血供;CT 检查示脾内均匀或不均匀低密度肿块,部分增强各期强化不明显,大部分动脉期轻度强化,静脉与延迟期持续进一步强化,稍低于或等于脾密度,以周边较明显;MRI 检查示T1WI、T2WI 序列多为低信号,大部分增强扫描各期未见强化,部分动脉期轻微强化,静脉及延迟期进一步明显强化。镜下可见增生的梭形细胞及浸润的慢性炎细胞及胶原纤维形成;免疫组化vimentin、SMA、Desmin、CD68 等表达阳性。72 例均行脾切除,随访4 个月至14 年,1 例术后2 年复发,1 例术后4 年发生肝转移。结论:SIMT 是较罕见的交界性间叶性肿瘤,临床无特征性,易误诊为恶性肿瘤,影像学检查有一定的诊断意义,确诊需病理学检查和免疫组化,脾切除是有效的治疗方法,预后良好,但需长期随访。


Diagnosis and treatment of splenic inflammatory myofibroblastic tumor: a report of 72 cases and literature review

Abstract

Objective: Objective: To review the clinicopathologic characteristics, diagnosis and treatment of splenic inflammatory myofibroblastic tumor (SIMT). Methods: Clinical data of SIMT patients including 4 cases admitted in Guangzhou General Hospital of Guangzhou Military Command and 68 cases extracted from literature reports were collected. The main clinical manifestations, imaging features, pathological diagnosis, treatment and results of the patients were analyzed and summarized. Results: The majority of the patients were male adults, left upper abdominal pain was the initial and main symptom, which was often accompanied with other systemic symptoms such as fever, fatigue, weight loss and anemia, and most of the tumors were solitary and localized with clear margins as shown by imaging examinations. B-ultrasonography showed heterogeneous echogenic masses in the spleen, with absent or barely visible color Doppler flow; CT scan showed homogeneous or heterogeneous low-density lesions in the spleen, some of which had no obvious enhancement in any contrast-enhanced phase, and most of which had slight enhancement in the arterial phase, and continuously increased enhancement in the venous and delayed phase, with the density lower than or similar to that of the spleen, and more evident change in the rims; lesions typically showed low signal on both the T1WI and T2WI in MRI imaging, most of which demonstrated no enhancement during enhanced scanning, some of which had slight enhancement in arterial phase, and continuously increased enhancement in venous and delayed phase. Hyperplastic spindle cells, chronic inflammatory cell infiltration, and collagen fibril formation were seen under microscope; immunohistochemical staining was positive for vimentin, SMA, Desmin and CD68. All the 72 patients underwent splenectomy, and followed-up ranged from 4 months to 14 years; recurrence occurred in one case 2 years after operation, and hepatic metastases occurred in one case 4 years after operation. Conclusion: SIMT is a rare borderline mesenchymal tumor, with no clinical characteristics, and can be easily misdiagnosed as malignant tumor, for which, imaging examinations have certain diagnostic significance, and diagnosis relies on immunohistochemical and pathological examination; splenectomy is the effective treatment method and prognosis is favorable, but long-term postoperative follow-up is necessary.


comments powered by Disqus

全文

引用

引用本文: 明信 李, 育洪 陈, 贤胜 朱, 晓东 陈, 秋林 廖, 建青 马. 脾炎性肌纤维母细胞瘤的诊断与治疗:附72 例报告并文献复习[J]. 中国普通外科杂志, 2015, 24(8): 1159-1165.
Cite this article as: LI Mingxin, CHEN Yuhong, ZHU Xiansheng, CHEN Xiaodong, LIAO Qiulin, MA Jianqing . Diagnosis and treatment of splenic inflammatory myofibroblastic tumor: a report of 72 cases and literature review[J]. Chin J Gen Surg, 2015, 24(8): 1159-1165.