Shiozawa Kazue, Watanabe Manabu, Igarashi Yoshinori, Ichimori Mioe, Hirano Naoki, Nakano Shigeru, Maeda Tetsuya, Yamazaki Kunihiro, Okubo Youichiro, Nemoto Tetsuo, Shibuya Kazutoshi, Sumino Yasukiyo
Departments of Hepatology and Gastroenterology, Toho University Medical Center, Omori Hospital, Tokyo, Japan.
Case Rep Gastroenterol. 2011 Sep;5(3):558-64. doi: 10.1159/000332443. Epub 2011 Sep 20.
There have been case reports of small intestinal gastrointestinal stromal tumors (GISTs) complicated with arteriovenous malformation (AVM) and angiodysplasia and exhibiting intense tumor staining. Herein we report a GIST of the small intestine that showed tumor staining and early venous return on imaging studies, and so the patient was suspected to have AVM. A 62-year-old male presented with intermittent pain in the left abdominal region. Contrast-enhanced computed tomography revealed a 15-mm-long spindle-shaped mass showing intense tumor staining and early venous return through the jejunal vein. In the arterial phase, the attenuation value of the tumor was 250 Hounsfield units. Color Doppler ultrasonography simultaneously delineated vessels extending from the serosal side and turbulent signals showing a mosaic pattern in the tumor. On angiography, intense staining was observed in the peripheral part of the second branch of the jejunal artery. Although these findings suggested AVM, the tumor was diagnosed as a GIST based on pathological examination of the resected specimens. In this case, no AVM or change in vascular density was noted despite the careful examination of pathological specimens, and the cause of the tumor staining remained unknown.
已有小肠胃肠道间质瘤（GIST）合并动静脉畸形（AVM）和血管发育异常并表现出强烈肿瘤染色的病例报告。在此，我们报告一例小肠GIST，其在影像学检查中显示肿瘤染色和早期静脉回流，因此患者被怀疑患有AVM。一名62岁男性出现左腹部间歇性疼痛。增强计算机断层扫描显示一个15毫米长的梭形肿块，表现出强烈的肿瘤染色并通过空肠静脉早期静脉回流。在动脉期，肿瘤的衰减值为250亨氏单位。彩色多普勒超声同时显示从浆膜侧延伸的血管以及肿瘤内呈镶嵌样的紊乱信号。在血管造影中，在空肠动脉第二分支的周边部分观察到强烈染色。尽管这些发现提示AVM，但根据切除标本的病理检查，该肿瘤被诊断为GIST。在本病例中，尽管对病理标本进行了仔细检查，但未发现AVM或血管密度改变，肿瘤染色的原因仍然不明。
