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GRNTI 76.03 Медико-биологические дисциплины
GRNTI 76.33 Гигиена и эпидемиология
OKSO 14.04.02 Ядерные физика и технологии
OKSO 31.06.2001 Клиническая медицина
OKSO 32.08.12 Эпидемиология
OKSO 31.08.08 Радиология
BBK 51 Социальная гигиена и организация здравоохранения. Гигиена. Эпидемиология
BBK 534 Общая диагностика
TBK 5708 Гигиена и санитария. Эпидемиология. Медицинская экология
TBK 5712 Медицинская биология. Гистология
TBK 5734 Медицинская радиология и рентгенология
TBK 6212 Радиоактивные элементы и изотопы. Радиохимия
Purpose: To describe own observation of inflammatory myofibroblastic tumor (IMT) of mesentery with a significant fatty component, retrospectively evaluate the diagnostic capabilities of computed tomography (CT). Material and methods: CT with bolus intravenous administration of 100 ml of contrast agent Ultravist-370 was performed by multislice computed tomograph Aquilion 64 Toshiba. Results: Patient M., 55 years old, was admitted to the clinic in July 2016 for surgical treatment due to the tumor in the abdominal cavity, which was detected by CT in May 2016. From the history it is known that since January 2016 the patient began to complain of weakness and weight loss. There were no abnormalities during physical examination and in the laboratory data. For staging pathological process control CT of the abdominal cavity with intravenous contrast was performed and then compared with previous CT scan. On the images of CT examination in the May 2016 in the mesogaster to the right of the median line oval shaped mass was defined, its seizes were 51×55×58 mm. On the present images seizes have reduced by about 10mm, more significantly decreased the volume of the mass – from 87 ml to 54 ml. The tumor is located directly under the anterior abdominal wall, surrounded by a loop of the small intestine. The outlines of mass were clear and smooth. The structure was not uniform due to inclusions of areas of fat (–75 HU) ranging in size from 4 mm to 29×16 mm, soft tissue component demonstrated the accumulation of contrast agent from 35 HU in the native phase to a maximum of 74 HU in delayed phase. There were not any other changes in the abdomen. So after 2 months at the control CT scan before the planned surgery we observed positive changes in the form of reducing the size and more significantly volume of the lesion. In the differential range we considered fat-containing tumors – teratoma and liposarcoma. We did not think about inflammatory myofibroblastic tumor (IMT) as well as gastrointestinal stromal tumor, since the guidelines for X-ray diagnostics and different overviews of these tumors does not mention the possibility of the presence of fat in their structure. However, there were not any pathognomonic features of teratoma like calcification, cystic component, levels of fat / liquid. The outline of the mass was smooth and clear, so we could suggest an expansive rather than infiltrative growth, which has also made the conclusion about liposarcoma unlikely. After preoperative preparation surgery was performed in the amount of resection of the small intestine segment with tumor and making enteroenteroanastomosis «end to end». After the morphological and immunohistochemistry analysis IMT of mesentery of small intestine was diagnosed. Conclusion: 1. Fatty component in the structure of lesion of the mesentery of the small intestine does not rule out IMT. 2. Theoretically we can assume the possible presence of fat in the structure of the IMT any location. 3. Consideration should be given by IMT in the case of spontaneous reduction of the size of the observed tumor.
inflammatory myofibroblastic tumor, mesentery, fatty component, computed tomography
Воспалительная миофибробластическая опухоль (ВМО) представляет собой редко встречающийся опухолевый процесс мезенхимального происхождения, который также известен как воспалительная псевдо-опухоль, воспалительная фибросаркома и др. Это заболевание впервые описал в легком Brunn в 1939 г., а термин «воспалительная псевдоопухоль» ввел Umiker в 1954 г. из-за склонности симулировать злокачественный процесс как клинически, так и поданным рентгенографии. В литературе описаны совершенно различные локализации ВМО, чаше всего они встречаются в легких, при этом около 43 % внелегочных поражений приходится на брыжейку тонкой кишки. Причины заболевания неизвестны. Часть поражений связывают с инфекцией (микоплазма, нокардии, актиномицеты, вирус Эпштейн–Барра, ВИЧ), травмой, предшествующим оперативным вмешательством, а также с аутоиммунными процессами. Как правило, заболевают дети и подростки, но опухоль может быть диагностирована и у взрослых. Чаще всего ВМО брыжейки тонкой кишки протекает бессимптомно. Поражение может достичь больших размеров, прежде чем возникнет болевой синдром или осложнения, как правило, связанные с обструкцией тонкой кишки. Однако у больного также могут быть системные клинические проявления в виде лихорадки, слабости, потери веса и анемии.
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