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一例罕见的原发性小肠去分化脂肪肉瘤致肠套叠:病例报告

A rare case of primary small bowel de-differentiated liposarcoma causing intussusception: A case report.

作者信息

Matsuo Kentaro, Inoue Masaya, Shirai Yasutsugu, Kataoka Tatsuki, Kagota Shuji, Taniguchi Kohei, Lee Sang-Woong, Uchiyama Kazuhisa

机构信息

Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki Department of Gastroenterological Surgery, Katsuragi Hospital, Habu cho, Kishiwada, Osaka Department of Diagnostic Pathology, Kyoto University Graduate School of Medical Science, Shogoin Kawahara-cho, Sakyo-ku Kyoto Translational Research Program, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan.

出版信息

Medicine (Baltimore). 2018 Jun;97(24):e11069. doi: 10.1097/MD.0000000000011069.

Abstract

RATIONALE

Liposarcoma (LPS) is a relatively rare malignant soft tissue tumor. Management of LPS including diagnosis is difficult, because it has no characteristic symptoms and no established effective treatment. Herein we reported an extremely rare case of intussusception induced by primary small bowel LPS.

PATIENT'S CONCERN: A-84-year-old male was a consult to our Emergency Department with symptoms of a terrible general fatigue, abdominal pain, and vomiting.

DIAGNOSIS

Abdominal ultrasonography and computed tomography (CT) revealed probable intussusception.

INTERVENTIONS

After decompression by insertion of an ileus tube, surgery was performed.

OUTCOMES

The ileum and mesentery of the small intestine had invaginated into the colon. There was no evidence of metastases in the intraabdominal space. The Hutchinson maneuver could not release the invagination, and so ileocecal resection with lymph node dissection was performed. Histopathological examination showed evidence of the growth of spindle-shaped cells. Also, immunohistochemical examination indicated the tumor to be a de-differentiated LPS. The patient was discharged on postoperative day 19 without any complications; and no recurrence of the tumor was observed at 16 months post operation.

LESSONS

LPS should be considered in the differential diagnosis of adult intussusception, and careful management should be required, including observation, after surgery.

摘要

理论依据

脂肪肉瘤(LPS)是一种相对罕见的恶性软组织肿瘤。LPS的管理,包括诊断,都很困难,因为它没有特征性症状且没有既定的有效治疗方法。在此,我们报告了一例由原发性小肠LPS引起的极为罕见的肠套叠病例。

患者情况

一名84岁男性因严重全身乏力、腹痛和呕吐症状前来我院急诊科就诊。

诊断

腹部超声和计算机断层扫描(CT)显示可能存在肠套叠。

干预措施

插入肠梗阻导管减压后进行了手术。

结果

小肠的回肠和肠系膜套入结肠。腹腔内无转移迹象。哈钦森手法未能解除套叠,因此进行了回盲部切除及淋巴结清扫。组织病理学检查显示有梭形细胞生长的证据。此外,免疫组化检查表明该肿瘤为去分化型LPS。患者术后第19天出院,无任何并发症;术后16个月未观察到肿瘤复发。

经验教训

在成人肠套叠的鉴别诊断中应考虑LPS,术后应进行仔细管理,包括观察。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1905/6023844/f8b3e80db369/medi-97-e11069-g001.jpg

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