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回肠弥漫大B细胞淋巴瘤超声表现1例

2019-09-19 向志 朱天华 临床超声医学杂志

患者女,67岁,因“大便次数增多伴排便不尽,下腹隐痛1个月余”入院。体格检查:腹平软,左下腹稍压痛,无反跳痛及肌紧张。大便隐血试验:阳性;实验室检查:甲胎蛋白、癌胚抗原、CA-125及CA-199均正常。

患者女,67岁,因“大便次数增多伴排便不尽,下腹隐痛1个月余”入院。体格检查:腹平软,左下腹稍压痛,无反跳痛及肌紧张。大便隐血试验:阳性;实验室检查:甲胎蛋白、癌胚抗原、CA-125及CA-199均正常。
 
经阴道超声检查:绝经后子宫,大小、形态、宫壁实质回声及内膜均未见明显异常;双侧卵巢未显示;子宫底前方见一范围约14.5 cm×5.5 cm混合回声包块,形态欠规则,边界不清(包块部分切面与膀胱、子宫分界不清),包块周边部分为不均质弱回声,中央见气体样强回声,延时观察可见轻微肠道样蠕动。
 
CDFI:弱回声内可探及较丰富的血流信号(图1),其中一支动脉峰值流速41.2 cm/s,阻力指数0.68。超声提示:盆腔内实性占位,考虑肠道来源,倾向不良。遂行腹腔探查及肿瘤切除术,术中见:肝、胆囊、胰腺及十二指肠粘连重,距离回盲部约30 cm处见一大小约5 cm×6 cm的肿瘤,质中偏硬,与子宫及膀胱粘连但活动,余腹腔无腹水。病理结果:回肠弥漫大B细胞淋巴瘤



图1 回肠弥漫大B细胞淋巴瘤彩色血流图
 
讨论:
 
淋巴瘤是起源于淋巴造血系统的恶性肿瘤,根据不同的淋巴细胞起源,可以分为B细胞、T细胞及NK细胞淋巴瘤。原发性肠道淋巴瘤起病隐匿,早期缺乏特异性,临床常见表现为腹痛、腹部包块、便血及消瘦等。肠道淋巴瘤起源于肠壁黏膜下层的淋巴组织,在黏膜下层及固有肌层浸润,好发于淋巴丰富的回肠末端和盲肠,其次为右半结肠。
 
本例患者包块因与子宫粘连,且位于盆腔内,故最初考虑是否来源于子宫或附件,但仔细观察发现其中央有类似肠道气体样蠕动回声,且仅与子宫底部少许分界不清,故考虑肠道来源可能性大。因肠道淋巴瘤较少见,故初诊时未考虑到该疾病的可能,临床工作中超声医师应多观察包块周边情况,以及是否有肿大淋巴结,提高超声诊断的准确性。
 
原始出处:

向志,朱天华.回肠弥漫大B细胞淋巴瘤超声表现1例[J].临床超声医学杂志,2018(04):263.

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    2019-09-21 thm112988

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    2019-09-21 zhaojie88

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