Imagami Toru, Togawa Takeshi, Oe Yasumitsu, Mizumoto Akiyoshi, Hino Michiko, Takemura Shizuki
Department of Digestive surgery and Peritoneal dissemination center, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
Department of Pathology, Kusatsu General Hospital, Kusatsu City, Japan.
Radiol Case Rep. 2022 May 20;17(7):2573-2578. doi: 10.1016/j.radcr.2022.03.066. eCollection 2022 Jul.
An 80-year-old man was referred to our hospital because of epigastric pain. Abdominal computed tomography revealed a well-defined circular intra-abdominal mass in the gastro-pancreatic region measuring 15 mm in diameter. After 6 months, the mass lesion was growing with mild enhancement, and weaker enhancement was found in the lower half of the mass on contrast-enhanced computed tomography. The mass lesion touched the stomach, whereas adipose tissue appeared to intervene between the mass and pancreas. On magnetic resonance imaging, the well-defined mass lesion had isointensity to muscle on T1-weighted imaging, slight hyperintensity to muscle on T2-weighted imaging, which indicated a rich fibrous tumor. Under general anesthesia, the patient underwent open surgery. Intraoperatively, the tumor was separated from the stomach and firmly attached to the pancreas. Therefore, we performed a distal pancreatomy with splenic resection. Pathological diagnosis was desmoid-type fibromatosis in the retroperitoneum, and the tumor margin was attached to the pancreas, splenic artery, and splenic vein. Since there are few reports of desmoid-type fibromatosis occurring in the retroperitoneum of the gastropancreatic region, it is difficult to distinguish from other soft tissue tumors and to identify the tumor origin. Close observation by radiological re-valuation was a useful option. Magnetic resonance imaging signals and an enhanced pattern may help distinguish a desmoid-type fibromatosis from other soft tissue tumors. A desmoid-type fibromatosis that is well-defined in radiological findings may infiltrate the surrounding organs with gross or pathological analyses.
一名80岁男性因上腹部疼痛被转诊至我院。腹部计算机断层扫描显示胃胰区域有一个边界清晰的圆形腹内肿块，直径为15毫米。6个月后，肿块病变在增强计算机断层扫描中显示有轻度强化且增大，肿块下半部分强化较弱。肿块病变与胃接触，而脂肪组织似乎介于肿块与胰腺之间。在磁共振成像中，边界清晰的肿块病变在T1加权成像上与肌肉等信号，在T2加权成像上略高于肌肉信号，提示为富含纤维的肿瘤。在全身麻醉下，患者接受了开放手术。术中，肿瘤与胃分离并牢固附着于胰腺。因此，我们进行了远端胰腺切除术并切除脾脏。病理诊断为腹膜后韧带样型纤维瘤病，肿瘤边缘附着于胰腺、脾动脉和脾静脉。由于关于胃胰区域腹膜后韧带样型纤维瘤病的报道较少，因此难以与其他软组织肿瘤区分开来并确定肿瘤起源。通过放射学重新评估进行密切观察是一种有用的选择。磁共振成像信号和强化模式可能有助于将韧带样型纤维瘤病与其他软组织肿瘤区分开来。在放射学检查中边界清晰的韧带样型纤维瘤病在大体或病理分析中可能会浸润周围器官。
