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中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 547 -552. doi: 10.3877/cma.j.issn.1674-3253.2024.06.003

所属专题: 经典病例

临床研究

膀胱炎性肌纤维母细胞瘤四例诊治报告并文献复习
王华1, 曹素娥2, 吴建杰1, 狄金明1,()   
  1. 1.510630 广州,中山大学附属第三医院泌尿外科
    2.510630 广州,中山大学附属第三医院影像科
  • 收稿日期:2024-06-06 出版日期:2024-12-01
  • 通信作者: 狄金明
  • 基金资助:
    广东省自然科学基金(2021A1515012322)

Diagnosis and treatment of inflammatory myofibroblastic tumor of urinary bladder: report of four cases and literature review

Hua Wang1, Su'e Cao1, Jianjie Wu1, Jinming Di1,()   

  1. 1.Department of Urology,2Department of Radiology,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China
  • Received:2024-06-06 Published:2024-12-01
  • Corresponding author: Jinming Di
引用本文:

王华, 曹素娥, 吴建杰, 狄金明. 膀胱炎性肌纤维母细胞瘤四例诊治报告并文献复习[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 547-552.

Hua Wang, Su'e Cao, Jianjie Wu, Jinming Di. Diagnosis and treatment of inflammatory myofibroblastic tumor of urinary bladder: report of four cases and literature review[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(06): 547-552.

目的

总结分析膀胱炎性肌纤维母细胞瘤临床及影像学特征,旨在提高该罕见病的临床诊治水平。

方法

回顾性分析2008年12月至2023年7月中山大学附属第三医院病理确诊为膀胱炎性肌纤维母细胞瘤4例患者的临床诊治过程并结合文献进行复习总结。

结果

4例患者均表现明显尿路刺激征,其中2例伴有肉眼血尿。增强CT见黏膜下边界清晰病灶,膨胀性生长,环形或延迟强化。MRI T2WI显示高信号,增强扫描病灶明显强化。所有病例行膀胱部分切除术,完整切除肿瘤。

结论

膀胱炎性肌纤维母细胞瘤是一种罕见良性肿瘤,具有低度恶性潜能,易误诊为膀胱恶性肿瘤。当CT或MR下病灶表现为起源黏膜下息肉样并向四周膨胀性生长,典型“环形”强化或渐进性强化特点时应高度警惕膀胱炎性肌纤维母细胞瘤可能。此外,常规行膀胱肿物活检十分必要,可明确肿瘤性质,避免误诊误治。接受膀胱部分切除术完整切除肿瘤,效果确切,患者预后良好。

Objective

To investigate the clinical and imaging features of inflammatory myofibroblastic tumor of urinary bladder (IMTUB),aiming to improve the clinical diagnosis and treatment of this rare disease.

Methods

The clinic data of 4 cases IMTUB confirmed by pathology from December 2008 to July 2023 were retrospectively analyzed,and related literatures were reviewed.

Results

All cases were presented with severe urinary irritation while two of them complained gross hematuria. It can be described as clear submucosal border lesions grow in an expansive way and annular or delayed enhancement on contrast-enhanced CT. MRI showed slightly higher signal intensity on T2WI,enhancement of lesions was obvious after enhancement. Partial cystectomy was performed to completely remove the tumor in all cases.

Conclusions

IMTUB is a rare benign tumor with low malignant potential and is easily misdiagnosed as a malignant bladder tumor. It should be strongly suspect to IMTUB while the lesions on CT or MR appear to the following features,including the submucosal polyps grow in a nodular expansive way,annular enhancement sign or delayed contrast enhancement sign. In addition,routine biopsy of bladder tumors is necessary for this type of tumor to clarify the nature and avoid misdiagnosis. Partial cystectomy is a good choice to cure this disease which has a good prognosis.

表1 四例膀胱炎性肌纤维母细胞瘤患者的临床特征
图1 膀胱炎性肌纤维母细胞瘤患者CT 表现 注:a和d示CT平扫见膀胱内占位,呈等密度;b和e示动脉期肿瘤外周“环形”强化或内部不均强化;c和f示静脉期肿瘤表现为持续强化,肿块周围膀胱壁增厚,可见强化;红色箭头示病灶
图2 膀胱炎性肌纤维母细胞瘤患者MRI表现 注:a和e为MRI示膀胱占位T1WI呈现低/等信号;b和f示T2WI稍高信号;c和g示DWI呈明显高信号;d和h示增强可见肿瘤呈现明显强化现象;红色箭头示病灶
表2 四例膀胱炎性肌纤维母细胞瘤患者的影像学特征
图3 膀胱炎性肌纤维母细胞瘤患者术后病理 注:a和d示肿物大体标本(肿物结节状,切面呈灰白色,有黏液,可见结节,质韧,实性,肿瘤表面溃疡出血);b和e示镜下100倍可见增生的长梭形肿瘤细胞(HE);c和f示镜下200倍可见增生的长梭形肿瘤细胞(HE)
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