Feng Dan,Li Zheng.Analysis of difficulties in the diagnosis and treatment of gastrointestinal lymphoma in children with intussusception as an initial presentation[J].Journal of Clinical Pediatric Surgery,,():159-164.[doi:10.3760/cma.j.cn101785-202502034]
Analysis of difficulties in the diagnosis and treatment of gastrointestinal lymphoma in children with intussusception as an initial presentation
- Keywords:
- Lymphoma; Gastrointestinal Tract; Intussusception; Diagnosis; Therapy; Child
- Abstract:
- Objective To explore the clinical characteristics of gastrointestinal lymphoma (GIL) in children with intussusception so as to boost the levels of its diagnosis and treatment. Methods The relevant clinical data were retrospectively reviewed for 33 GIL children with intussusception operated from March 31,2009 to July 31,2023.Follow-ups were conducted until February 2025.General profiles (gender,onset age & duration of disease),laboratory parameters,imaging studies,pathological examinations,treatments and outcomes were recorded. Results Among them,there were 26 boys and 7 girls with an onset age of 1 to 13 year.Seven cases were aged 5 year.Abdominal pain occurred over 48 h (n=27) and within 48 h (n=6).The level of lactate dehydrogenase (LDH) surpassed 1299 U/L(n=4).There were large tumors with multiple metastatic lesions (n=4).In another case.metastasis in mesenteric lymph node and appendix were detected by postoperative pathology examination.And 2/4 cases revealed bone marrow (BM) metastasis by BM aspiration.Nine of them were aged under 5 year.Initial ultrasonic examinations (excluding intussusception) revealed no abnormalities.And 6/9 cases hinted at merely swelling and stiffness of intestinal wall during surgery.And 24 cases were aged 5 years or above.Local masses were detected in all of them during surgery.Hypoechoic ultrasonic masses were reported at an initial diagnosis.Surgical procedures included laparoscopy (n=4),conversion into open surgery due to difficulties of intussusception reduction (n=2) and reoperation for recurrent intussusception due to abnormal intestinal wall swelling and rigidity (n=2). Postoperative pathological examinations confirmed non-Hodgkin lymphoma.Seven cases became lost to follow-ups.In the remainders,21 received postoperative chemotherapy was offered (n=21) and there were complete remission (n=20) and relapse (n=1).In another 5 cases,there were no abnormalities (n=3) and death from rapid disease progression (n=2). Conclusions Age 5 has been a high incidence age of GIL in children.When tumor is manifested merely as swelling and stiffness of intestinal wall,it is a major cause of diagnostic difficulties through imaging and laparoscopy.When LDH value is 5 folds above its upper limit of normal,there are also accompanied by large tumor lesion,multiple metastatic lesions and (or) BM metastasis.
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Memo
收稿日期:2025-2-18。
通讯作者:李争,Email:lizheng0412@126.com