多层螺旋CT在胃淋巴瘤及胃...内分泌肿瘤中的鉴别诊断价值_吴胜男.pdf

转化医学杂志 2022年12月 第11卷 第6期Translational Medicine Journal,Vo1.11 NO.6,Dec 2022多层螺旋CT在胃淋巴瘤及胃神经内分泌肿瘤中的鉴别诊断价值吴胜男，霍鲁月，庄帅帅，孙为豪 摘要 目的 比较原发性胃淋巴瘤(primary gastric lymphoma，PGL)和胃神经内分泌肿瘤(gastric neuroendocrinetumor，G-NET)的CT征象，为临床诊断及鉴别诊断提供影像学依据。方法 纳入经病理证实的38例PGL患者和23例G-NET患者，对比两者的临床资料及CT特征，包括病变大小、部位、数目、形态、CT强化特征、黏膜及浆膜完整性，胃周淋巴结及其他器官侵犯情况。结果 G-NET患者多表现为胃多发性隆起样病变，数目多发、散发，集中于胃体部，与临近胃壁界限清，未见明显浆膜受累，肿瘤形态以圆形或半圆形隆起最多见，CT增强扫描呈轻中度不均匀强化。PGL患者均有不同程度的弥漫胃壁增厚，溃疡形态多见，病变部位主要包括胃窦胃体，与邻近胃壁界限不清或相延续。CT增强扫描呈轻度均匀延迟强化。通过对两组患者的CT表现分析，两组患者在年龄(P=0.024)、肿瘤大小(P0.001)、数目(P0.001)、强化方式(P0.001)均有统计学意义。随后对以上特征进行多因素分析，肿瘤大小(OR=4.757，P=0.005)、数目(OR=0.087，P=0.045)可作为G-NET和PGL的独立鉴别因子。结论 多层螺旋CT对于G-NET和PGL的鉴别诊断有一定的临床价值。关键词 胃淋巴瘤；胃神经内分泌肿瘤；螺旋CT；鉴别诊断 中图分类号 R730.44;R735.2 文献标志码 A 文章编号 2095-3097（2022）06-0347-04doi:10.3969/j.issn.2095-3097.2022.06.004Value of multislice spiral CT scanning in differential diagnosis of gastricneuroendocrine tumor and primary gastric lymphomaWU Shengnan1，HUO Luyue2,ZHUANG Shuaishuai2,SUN Weihao2(1Department of Geriatric Medicine,the First Affiliated Hospital of Wanan Medical College,Wuhu Anhui 241000,China;2Department of Geriatric Gastroenterology,First Affiliated Hospital of Nanjing Medical University，Nanjing Jiangsu210029,China)Abstract Objective To explore the power of CT signs in differential diagnosis of PGL and G-NET.MethodsSixty-one patients including 38 PGL and 23 G-NET confirmed by pathology were enrolled.Clinical and CT features including tumor size,tumor number,tumor location,tumor morphology,CT characteristics,mucous membrane and serousmembrane integrity,lymph nodes,and organs metastasized were compared between the two groups.Results G-NET patients mostly presented with multiple uplift-like lesions in the stomach,which were numerous and sporadic,concentrated in the body of the stomach,with a clear boundary with the adjacent gastric wall,and no obvious serosal involvementwas observed.The tumor morphology was mostly circular or semicircular uplifts,and CT enhanced scan showed mild tomoderate uneven enhancement.PGL patients had varying degrees of diffuse gastric wall thickening and ulcer morphology was common.The lesion sites mainly included gastric antrum and gastric body,with unclear boundary or continuousphase with adjacent gastric wall.CT enhanced scan showed mild uniform delayed enhancement.CT findings of the twogroups showed statistically significant differences in age(P=0.024),tumor size(P0.001),number(P0.001)and enhancement method(P20 mm肿瘤，转移可能性大(50%)的观点相符合16。PGL 沿黏膜和黏膜下层浸润，沿器官长轴生长，故胃壁增厚明显、范围广，CT表现为胃壁弥漫性增厚。镜下溃疡形较多，溃疡较大，形态不规则、呈多形性，表面覆厚苔或秽苔，病变部位主要包括胃窦胃体，幽门受累较为少见，PGL 与 Hp 感染有关，而Hp胃内定植部位正是胃体和胃窦，Hp感染后引起胃黏膜内淋巴细胞聚集，促进PGL的发生。部分文献报道抗Hp治疗可以使胃 DLBCL 的完全缓解率达到80%17。PGL大多数密度较为均匀，未见坏死、钙化，增强后无明显强化，类似于肌肉强化程度。研究指出，PGL在黏膜处累及较晚，在增强以后，病变表面的胃黏膜表现为细线样强化，但病变不具有明显强化，此征象被视为淋巴瘤的一个特征性表现18。本组38例PGL中只有3例表现为浆膜层模糊，此与文献报道相符19。可能与PGL沿器官长轴生长，侵犯浆膜层较晚有关。本研究不足之处：本研究样本量小；因为病变较少见，病例的代表性有限，后期需扩大样本量完善研究；本研究中只采用了常用的CT 征象指标进行研究，可能会影响诊断效能，需进一步研究。综上所述，MSCT增强扫描可对G-NET和PGL诊断及鉴别诊断提供可靠的参考价值，并可在一定程度上反映两者的病理特点。G-NET与 PGL的CT表现各有特点，G-NET病变多发且多位于胃体，CT呈轻中度不均匀强化，PGL病变多呈单发，伴有弥漫性胃壁增厚、CT呈轻度均匀强化。MSCT可清晰地显示胃壁病变的厚度、浸润范围和类型并显现病灶与周围组织的关系，对鉴别两者有重要的价值。【参考文献】1Al-Akwaa AM,Siddiqui N,Al-Mofleh IA.Primary gastric lymphoma J.World J Gastroenterol,2004,10(1):5-11.2 Fan JH,Zhang YQ,Shi SS,et al.A nation-wide retrospective epidemiological study of gastroenteropancreatic neuroendocrineneoplasms in china J.Oncotarget,2017,8(42):71699-71708.3蒋松松,陈刚,郑黎明,等.胃神经内分泌癌、未分化癌误诊为胃恶性淋巴瘤分析 J.临床误诊误治,2015,28:10-13.4 Yao J C,Hassan M,Phan A,et al.One hundred years after carcinoid:epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States J.J Clin Oncol,2008,26(18):3063-3072.5Liang P,Wang YX,Ren XC,et al.Neuroendocrine carcinoma ofthe stomach:clinical features and CT findings J.Abdom Radiol(NY),2016,41(1):19-24.6Rindi G,Kloppel G,Couvelard A,et al.TNM staging of midgutand hindgut(neuro)endocrine tumors:a consensus proposal including a grading system J.Virchows Arch,2007,451(4):757-762.7Cives M,Strosberg JR.Gastroenteropancreatic NeuroendocrineTumors J.CA Cancer J Clin,2018,68(6):471-487.8Olszewska-Szopa M,Wrobel T.Gastrointestinal non-Hodgkinlymphomas J.Adv Clin Exp Med,2019,28(8):1119-1124.9陈国栋,高莉,曹珊,等.原发性胃淋巴瘤的临床、内镜、病理分析与预后因素J.中华消化杂志,2017,37:438-441.10 张梦然,庞铭歌,张玫.原发性胃肠道淋巴瘤的临床、内镜及组织病理学特点分析(附41例报告)J.中国内镜杂志,2021,27:60-66.11 Yang HJ,Lee C,Lim SH,et al.Clinical characteristics of primary gastric lymphoma detected during screening for gastric cancerin KoreaJ.J Gastroenterol Hepatol,2016,31(9):1572-1583.12 Jurez-Salcedo LM,Sokol L,Chavez JC,et al.Primary GastricLymphoma,Epidemiology,Clinical Diagnosis,and TreatmentJ.Cancer Control,2018,25(1):1073274818778256.13 Kelessis NG,Vassilopoulos PP,Bai MP,et al.Update of the roleof surgery in the multimodal treatment of MALT gastric lymphomas J.Anticancer Res,2002,22(6B):3457-3463.14 Pavel M,Oberg K,Falconi M,et al.Gastroenteropancreatic neuroendocrine neoplasms:ESMO Clinical Practice Guidelines fordiagnosis,treatment and follow-up J.Ann