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炎性纤维瘤性息肉:一种罕见的儿童消化道良性肿瘤,表现为肠套叠——病例报告及文献复习

Inflammatory fibroid polyp: a rare benign tumor of the alimentary tract in children presenting as intussusception-case report and review of literature.

作者信息

Siminas Sotirios, Qasem Eyas, Shukla Rajeev, Turnock Richard

机构信息

Department of Paediatric Surgery and Urology, Manchester Children's Hospital, Manchester, United Kingdom.

Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom.

出版信息

European J Pediatr Surg Rep. 2014 Jun;2(1):16-9. doi: 10.1055/s-0033-1354746. Epub 2013 Sep 9.

Abstract

Inflammatory fibroid polyp (IFP) represents a rare cause of gastrointestinal polypoid disease in childhood. Τhe lesion has been described by various names beyond the currently accepted term, including "Vanek's tumour," eosinophilic or submucosal granuloma, gastric fibroma with eosinophilic infiltration, inflammatory pseudotumor, and hemangiopericytoma. The etiopathogenesis and origin of the mesenchymal spindle-shaped cells that comprise the polyp remains enigmatic. Recent studies have shown familial occurrence, expression of platelet-derived growth factor receptor (PDGFRA) and oncogenic PDGFRA mutations in the majority of lesions, suggestive of a neoplastic nature. We present a rare case of a 10-year-old boy with an IFP of the terminal ileum, who presented acutely with intussusception and was treated with a right hemicolectomy. Postoperative course was uneventful and the patient has been asymptomatic during follow-up. Histopathology and immunohistochemical analysis excluded inflammatory myofibroblastic tumor (negative for Alk1, desmin, smooth muscle actin [SMA]), gastrointerstinal stromal tumors (GIST) (negative for CD117) and schwannoma (negative for S100). The lesion was positive for CD34 and faintly for vimentin. Despite the classification of IFPs as a mesenchymal benign neoplasm, in the vast majority of cases, surgical excision alone was curative, and no reports exist of a malignant transformation. A cautious approach with periodic surveillance of the affected children seems reasonable though.

摘要

炎性纤维瘤性息肉(IFP)是儿童胃肠道息肉样疾病的罕见病因。除了目前公认的术语外,该病变还有各种不同的名称,包括“瓦内克瘤”、嗜酸性或黏膜下肉芽肿、伴有嗜酸性浸润的胃纤维瘤、炎性假瘤和血管外皮细胞瘤。构成息肉的间充质梭形细胞的病因和起源仍然不明。最近的研究表明,大多数病变存在家族性发病、血小板衍生生长因子受体(PDGFRA)表达及致癌性PDGFRA突变,提示其具有肿瘤性质。我们报告一例罕见的10岁男孩,患有回肠末端IFP,因肠套叠急性发作就诊,接受了右半结肠切除术治疗。术后病程顺利,患者在随访期间无症状。组织病理学和免疫组化分析排除了炎性肌成纤维细胞瘤(ALK1、结蛋白、平滑肌肌动蛋白[SMA]阴性)、胃肠道间质瘤(GIST)(CD117阴性)和神经鞘瘤(S100阴性)。病变CD34阳性,波形蛋白弱阳性。尽管IFP被归类为间充质良性肿瘤,但在绝大多数病例中,仅手术切除即可治愈,且尚无恶性转化的报道。不过,对患病儿童进行定期监测的谨慎方法似乎是合理的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/102c/4336055/dd7367b4d512/10-1055-s-0033-1354746-i130089cr-1.jpg

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