Zhu Qing-Qiang, Zhu Wen-Rong, Wu Jing-Tao, Chen Wen-Xin, Wang Shou-An
Qing-Qiang Zhu, Wen-Rong Zhu, Jing-Tao Wu, Wen-Xin Chen, Shou-An Wang, Department of Medical Imaging, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
World J Gastroenterol. 2014 Apr 21;20(15):4446-52. doi: 10.3748/wjg.v20.i15.4446.
To characterize the clinical, radiological, endoscopic and pathological features of intestinal tuberculosis (ITB) and primary small intestinal lymphoma (PSIL).
This was a retrospective study from February 2005 to October 2012 of patients with a diagnosis of ITB (n = 41) or PSIL (n = 37). All patients with ITB or PSIL underwent computed tomography (CT) and pathological examination. Thirty-five patients with ITB and 32 patients with PSIL underwent endoscopy. These patients were followed for a further 18 mo to ascertain that the diagnosis had not changed. Clinical, endoscopic, CT and pathological features were compared between ITB and PSIL patients.
Night sweating, fever, pulmonary TB and ascites were discovered significantly more often in ITB than in PSIL patients (P < 0.05), however, abdominal mass, hematochezia and intestinal perforation were found significantly more frequently in PSIL than in ITB patients (P < 0.05). Ring-like and rodent-like ulcers occurred significantly more often in ITB than in PSIL patients (P < 0.05), however, enterorrhagia and raised lesions were significantly more frequent in PSIL than in ITB patients (P < 0.05). The rate of granuloma was significantly higher in ITB than in PSIL patients (87.8% vs 13.5%, χ(2) = 43.050, P < 0.05), and the incidence of confluent granulomas with caseous necrosis was significantly higher in ITB than in PSIL patients (47.2% vs 0.0%, χ(2) = 4.034, P < 0.05). Multi-segmental lesions, mural stratification, mural gas sign, and intestinal stricture were more frequent in ITB than in PSIL patients (P < 0.05), however, a single-layer thickening of bowel wall, single segmental lesions, and intussusception were more common in PSIL than in ITB patients (P < 0.05). Necrotic lymph nodes, comb sign and inflammatory mass were more frequent in ITB than in PSIL patients (P < 0.05). The bowel wall enhancement in ITB patients was greater than that in PSIL patients (P < 0.05), while the thickening and lymph node enlargement in PSIL patients were higher than those in ITB patients (P < 0.05).
Combined evaluation of clinical, radiological, endoscopic and pathological features is the key to differentiation between ITB and PSIL.
描述肠结核（ITB）和原发性小肠淋巴瘤（PSIL）的临床、放射学、内镜及病理特征。
这是一项回顾性研究，研究对象为2005年2月至2012年10月期间诊断为ITB（n = 41）或PSIL（n = 37）的患者。所有ITB或PSIL患者均接受了计算机断层扫描（CT）和病理检查。35例ITB患者和32例PSIL患者接受了内镜检查。对这些患者进行了为期18个月的随访，以确定诊断是否发生变化。比较了ITB和PSIL患者的临床、内镜、CT及病理特征。
盗汗、发热、肺结核和腹水在ITB患者中比在PSIL患者中更常见（P < 0.05），然而，腹部肿块、便血和肠穿孔在PSIL患者中比在ITB患者中更常见（P < 0.05）。环形和鼠咬状溃疡在ITB患者中比在PSIL患者中更常见（P < 0.05），然而，肠出血和隆起性病变在PSIL患者中比在ITB患者中更常见（P < 0.05）。ITB患者肉芽肿的发生率显著高于PSIL患者（87.8%对13.5%，χ(2)=43.050，P < 0.05），并且伴有干酪样坏死的融合性肉芽肿的发生率在ITB患者中显著高于PSIL患者（47.2%对0.0%，χ(2)=4.034），P < 0.05）。多节段病变、肠壁分层、肠壁积气征和肠狭窄在ITB患者中比在PSIL患者中更常见（P < 0.05），然而，肠壁单层增厚、单节段病变和肠套叠在PSIL患者中比在ITB患者中更常见（P < 0.05）。坏死淋巴结、梳状征和炎性肿块在ITB患者中比在PSIL患者中更常见（P < 0.05）。ITB患者的肠壁强化程度大于PSIL患者（P < 0.05），而PSIL患者的肠壁增厚和淋巴结肿大程度高于ITB患者（P < 0.05）。
综合评估临床、放射学、内镜及病理特征是鉴别ITB和PSIL的关键。
