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題名 | Endoscopic Diagnosis of Gastrointestinal Lipomas--A Review of Sixteen Cases=胃腸道脂肪瘤的內視鏡診斷--16病例回顧 |
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作者 | 梁金銅; 鄭永銘; 林秀峰; 孫家棟; 李伯皇; 王世名; 張金堅; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 30:3 民86.05-06 |
頁次 | 頁206-214 |
分類號 | 415.5091 |
關鍵詞 | 胃腸道脂肪瘤; 內視鏡診斷; Gastrointestinal lipoma; Endoscopy; |
語文 | 英文(English) |
中文摘要 | 胃腸道脂肪瘤雖是罕見,但由於可能酷似惡性腫瘤而治療上並不需要太 積極,所以在臨床上亦相當重要。 本文回顧ie例胃腸道脂肪瘤的臨床資料,並比較其內視鏡、放射線,以及組織學 特徵。結果顯示此ie病例的內視鏡表現可分成三群:山第 1類型:(1位病人),其表 現是邊緣整齊軟而帶黃色的腫瘤,並出現pillow,tenting,或rolling的表徵.(21第 u 類型(7位病人),其表現是堅固可動的息肉,並有表面潰瘍;131第 皿類型(2位病 人)。其表現是堅硬,潰瘍性的出血腫塊。在組織病理學上,我們可見這三群脂 肪瘤,其慢性發炎的程度逐漸增加。在治療前就得到確定診斷的病人有10位(7位 單靠內視鏡,3位靠鋇劑灌腸攝影和電腦斷層)。一例的胃部脂肪瘤靠術中冷凍切 片而診斷。一位直腸脂肪瘤在經息肉切除後偶然發現。四位病人被誤診。 我們的結論是脂肪瘤本身發炎反應會造成鑑別診斷上的困難。內視鏡在第I類型 的病人可得正確和治療效果。而在內視鏡無法立即診斷的病例(第II和III類型), 必須做鋇劑顯影,電腦斷層檢查,或甚至術中冷凍切片以求得正確診斷而免去病 人接受大手術。 |
英文摘要 | Gastrointestinal lipomas are rare but clinically important because theymay simulate malignancies but require much less aggressive treatment.Clinical data from 16 gastrointestinal lipomas were retrospectivelyreviewed. Their endoscopic features, radiologic findings and histologicalcharacteristics were compared. The 16 endoscopic findings were dividedinto (1) Category I (7 patients), presenting as a sharply demarcated,yellowish, soft mass with positive pillow, tenting, or rolling sign; (2)Category II (7 patients), presenting as a solid, polypoid, movable masswith superficial ulceration; and (3) Category III (2 patients), manifestedas an incompressible, ulcerated and" hemorrhagic mass. In histopathology,an increasing degree of chronic inflammation was noted from CategoryI, II, to III lipomatosis. Pre-treatment definitive diagnosis was made for 10patients (7 patients solely by endoscopy and 3 patients by barium contraststudy and computed tomography). One gastric lipoma was diagnosedby intraoperative frozen section. One rectal lipoma was diagnosedincidentally by endoscopic polypectomy. Four patients were misdiagnosed.We concluded that inflammatory changes of the lipoma itself confoundedthe differential diagnosis. Endoscopy offers an accurate diagnosis anddirect treatment in Category I cases. In endoscopically equivocal cases(Category II and III), barium contrast study, computed tomography, andeven intraoperative frozen section should not be withheld in order tofacilitate a definitive diagnosis, thus sparing the patients major surgery. |
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