1 case of invasive fibroids of the intestinal membrane.

Male, 57, was admitted to hospital for "upper abdominal pain accompanied by nausea, vomiting for 2 months, aggravated by more than 1 month".
check body: abdominal soft, mid-upper abdomen and an irregular soft tissue block, did not touch the upper edge, release the umbilical cord level, right to right collarbone inside line 2 cm, can be pushed, soft, tenderness obvious.
laboratory examination showed no obvious abnormalities.
CT examination: pancreas left front and lower see an uneven density of clumps of soft tissue lumps, size 9.3 cm x 7.9 cm x 9.7 cm, leaf-like, lesions and small intestine indistinct, enhanced scanning is moderately uneven Hardened, arterial period see angiopathy (Figure 1), venous lesions further strengthened, the degree of internal vascular strengthening than before reduced (Figure 2), crown, sapathic see the lump adjacent to the intestinal tube pressure passage, and the lump is not clearly bounded (Figure 3,4).
CT diagnosis is: inter-gastrointestinal leaf-derived tumor.
Figure 1 CT enhanced scanning artery period, the lesions are light moderate uneven reinforcement, the internal visible reinforcement of angiopic shadow; Figure 2 intravenous lesions further strengthened, its internal vascular strengthening degree decreased; Figure 3, 4, respectively, the coronal and saline images show the colonized adjacent intestinal tube pressure, with the lump semlosis surgery and pathology: large intestine and two-finger intestinal tract, partial colon, and pancreatic surgery, Medium probe and left upper abdomen about 14.0 cm x 12.0 cm x 10.0 cm pack block, near-empty intestine starting near end empty intestine wrapped around the surface of the block, about 35 cm long, and the block can not be separated, while the horizontal colon membrane root exploration and 5.0 cm x 5.0 cm block, soaked duo12 finger synapse, pancreatic dipokandic and half-cross edtrum.
pathological results: tumor size is 15.0 cm x 12.0 cm x 7.0 cm, 4.1 cm x 3.8 cm x 3.1 cm, tumor immersion duodenum, transverse coloncolon wall slurry membrane layer and muscle layer, partially soaked in the lower layer of colon mucosa.
pathological results considered (duodenum, transcolon) invasive intestinal membrane fibroids (Figure 5).
Figure 5, the tumor is composed of diffuse, beam-distributed shuttle cells, and is invasive growth, containing collagen fibers and rich blood vessels (HE x 200) immunohisic chemistry: Vimentin (), beta-Catenin (nuclear) (Figure 6), CD34 (-), CD1 17 (-), DOG-1 (-), PgP9.5 (-), S-100 Multi-Clone (-), CD57 (-), Calponin (-), SMA (-), Desmin (-), CK Wide (-), Ki-67 (5% to 8% plus).
Figure 6 Immunohist chemistry (x 100) staining: beta-Catenin (plus) discusses intestinal membrane invasive fibroids is a rare soft tissue tumor derived from interlolobal tissue, with a certain genetic tendency, mostly found in patients with Gardner syndrome, and is closely related to abdominal trauma, surgery, estrogen levels, but not with Gardner syndrome and violation of the duodenum and colon cases is very rare.
the disease can occur between 1 and 60 years old, the ratio of men to women about 1:3, with easy local recurrence but not easy to transfer characteristics.
its early clinical symptoms are hidden, the lump can cause a series of complications, such as abdominal lumps, abdominal pain, bloating, intestinal obstruction and so on. Although the
lacks specific clinical manifestations and signs, beta-Catenin positive plays an important role in the diagnosis of the disease.
intestinal membrane invasive fibroid disease mainLY CT performance is a clearer boundary of the real mass, form more regular, type of circular or leaf-like, local invasive changes, this case shows that the lump tired and the duodenum and horizontal colon wall, adjacent intestinal tube pressure, if the lesions can be connected with the intestinal cavity, can be shown as "cystic" or "gas-liquid flat" change.
enhancement scans are light and moderately enhanced, visible scattered in liquefied necrosis or blood vessels.
the imaging performance of the disease needs to be distinguished with the following diseases: (1) gastrointestinal mesopline, good hair age of 50 years or older, malignant is less of a morphological rule, the diameter of more than 5 cm, the density is mixed, the medium-to-severe uneven reinforcement.
(2) celiac lymphoma, can form a typical "sandwich sign", that is, intestinal membrane fat and blood vessels (sandwich filling) are wrapped in the two sides of the apparently large lymphoma lumps, the peritoneum and intestinal membrane lymphnode swelling is common, and the intestinal membrane invasive fibroids is not this performance.
(3) intestinal membrane metastatic tumor, often multiple, immersive growth, multi-border unclear.
(4) type of cancer, more rare, often occurs in the far end of the intestinal tract, the performance of the intestinal cavity lumps, 80% of the intestinal membrane when the performance of the strengthening of soft tissue lumps with radioactive strips extended to the intestinal membrane fat, and often calcification.
the disease is mainly surgical excision, after surgery conventional auxiliary chemotherapy to prevent tumor recurrence, but this case for economic reasons, did not carry out the treatment.
, intestinal membrane invasive fibroid disease is a kind of aggressive rare fibroid disease subtype, can be local recurrence, clinical manifestations lack of specificity, so diagnosis is more difficult, diagnosis needs to be combined with pathological results.
to master its CT performance can help improve the correct rate of preoperative diagnosis, provide a basis for the complete removal of tumors during surgery, and reduce the recurrence rate after surgery.
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