儿童胃肿瘤和肿瘤样病变的影像学诊断和鉴别诊断

目的分析儿童原发性胃肿瘤和肿瘤样病变的超声（US）、胃肠道造影检查（GI）、计算机断层成像（CT）和磁共振成像（MRI）的影像学表现，提高对儿童原发性胃肿瘤和肿瘤样病变的诊断和鉴别诊断。方法回顾性分析2008年1月-2013年5月经手术证实的17例儿童胃肿瘤和肿瘤样病变的临床和影像资料，包括胃重复畸形7例，胃异位胰腺2例，炎症性肌纤维母细胞瘤2例，未成熟畸胎瘤2例，间质瘤2例，胃憩室和低分化腺癌各1例。其中行US检查11例次，行GI检查9例次，行CT检查15例次，行MRI检查6例次，分析儿童原发性胃肿瘤和肿瘤样病变在影像学上的表现特征。结果17例患儿共发生20处病变，其中发生在胃窦部5例，胃底4例，胃体9例（胃大弯5侧，胃小弯侧4例），贲门2例。肿块平均长径为5．5cm，形态多样。囊性肿块7例均为重复畸形；1例气囊为胃憩室；1例含钙化的囊实性肿块为畸胎瘤；实性肿块8例，包括畸胎瘤、间质瘤、炎症性肌纤维母细胞瘤、腺癌和异位胰腺等。结论儿童原发性胃肿瘤和肿瘤样病变主要分为囊性和实性肿块，囊性或囊实性肿块（胃重复畸形、胃憩室和典型畸胎瘤）在影像学上有特征性，而胃实性肿块表现缺乏特征性。

Imaging diagnosis and differential diagnosis of gastric tumors and tumor-like lesions of children

Objective To analyze the imaging findings of the ultrasonography （US）, gastrointestinal imaging （GI）, computed tomography （CT）, and magnetic resonance imaging （MRI） of children＇s primary gastric tumors and tumor-like lesions and to improve the imaging diagnosis and differential diagnosis. Methods The clinical and imaging data of seventeen children with primary gastric tumors and tumor-like lesions that were confirmed by surgeries from January, 2008 to May, 2013 were retrospectively analyzed, including seven cases of gastric duplication, two cases of gastric ectopic pancreas, two cases of inflammatory myofiroblastic tumors, two cases of immature teratoma, two cases of stromal tumors, one case of gastric diverticulum, and one case of poorly differentiated adenocarcinoma. Eleven cases were examined by the US; nine cases were examined by the GI; 15 cases were examined by the CT scan; and six cases were examined by the MRI. The imaging features of the primary gastric tumors and tumor-like lesions of children were analyzed. Results Twenty lesions occurred among seventeen cases. Among which five lesions located in the antrum; four lesions located in the fundus; nine lesions located in the gastric body （ five in the greater curvature and four in the lesser curvature） ; and two lesions located in the gastric cardia. The average diameter of these lesions was 5.5 cm and their shapes were various. All seven cystic lesions were gastric duplications. One cystic-like lesion with air-fluid level was a gastric diverticulum. One solid-cystic mass with calcification was a teratoma. Eight solid masses were teratoma, gastric stromal tumor, inflammatory myofibroblastic tumor, adenocarcinoma, and ectopic pancreas. Conclusion Theprimary gastric tumors and tumor-like lesions of children are mainly cystic and solid masses. The cystic or cystic- solid masses （gastric duplication, diverticulum, and typical teratoma） have imaging characteristics while solid masses lack imaging characteristics.