CLEAR柯丽尔每日一例:增生性胃息肉

2022-09-14 放射沙龙 learningradiology

增生性胃息肉【概述】1.最常见的良性胃肿瘤2.伴有:(1)胃酸过多及胃溃疡(2)慢性萎缩性胃炎(3)胃癌3.恶性转化的发生率低。

56岁,胃痛

上消化道造影胃黏膜像

最可能的诊断是什么?

1.淋巴瘤

2.胃癌

3.异位胰腺巢

4.嗜酸细胞性胃肠炎

5.增生性息肉

【答案】

5.增生性息肉

【讨论】

增生性胃息肉

【概述】

1.最常见的良性胃肿瘤

2.伴有:

(1)胃酸过多及胃溃疡

(2)慢性萎缩性胃炎

(3)胃癌

3.恶性转化的发生率低

【临床表现】

1.通常偶然发现

2.可红肿、糜烂

3.出血罕见

4.胃窦附近的较大息肉可引起出口性胃梗阻

增生性息肉(炎性息肉)(75-90%)

1.增生的胃黏膜及炎性细胞

2.伴有恶性贫血

3.在胃内随机分布

4.常为多发

5.通常小于1cm者无进展

6.无恶性潜能

腺瘤性息肉(10-20%)

1.有极低恶性潜能的真性肿瘤(<4%)

2.与Gardner综合征、青少年息肉病及Cronkhite-Canada综合征有关

3.更长发生于胃窦

4.常单发

5.直径通常大于1.5cm

6.发生于大于50岁者

错构瘤性息肉(罕见)

1.密集的充满胃腺

2.与Peutz-Jeghers综合征有关

3.通常直径小于2cm

潴留性息肉(罕见)

1.囊状扩张的腺体

2.与Cronkhite-Canada综合征有关

绒毛状息肉(罕见)

可恶变

【鉴别诊断(DDX)】

1.巨大肥厚性胃炎(Menetrier disease)(胃窦不受累)

2.嗜酸细胞性胃息肉

3.淋巴瘤

4.胃癌

5.异位胰腺巢(胃窦)

增生性胃息肉:

上图:白箭头示胃前壁、后壁多发充盈缺损,一些被钡池勾勒出轮廓,另一些被钡剂覆盖的表示多发的、小的胃息肉。

下图:再次显示与上图相同的息肉(蓝箭头)。

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    2022-09-19 张振

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