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中华胃肠内镜电子杂志 ›› 2022, Vol. 09 ›› Issue (03) : 168 -172. doi: 10.3877/cma.j.issn.2095-7157.2022.03.011

病例报告

Cowden综合征1例并文献复习
张俊光1, 白鹏1, 林香春1,()   
  1. 1. 102206 北京,北京大学国际医院消化内科
  • 收稿日期:2022-06-09 出版日期:2022-08-15
  • 通信作者: 林香春

Cowden syndrome: a case report and brief review of literature

Junguang Zhang1, Peng Bai1, Xiangchun Lin1()   

  • Received:2022-06-09 Published:2022-08-15
  • Corresponding author: Xiangchun Lin
引用本文:

张俊光, 白鹏, 林香春. Cowden综合征1例并文献复习[J/OL]. 中华胃肠内镜电子杂志, 2022, 09(03): 168-172.

Junguang Zhang, Peng Bai, Xiangchun Lin. Cowden syndrome: a case report and brief review of literature[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2022, 09(03): 168-172.

患者男,44岁,主因"大便次数改变1月余",于2020年4月26日收住北京大学国际医院消化内科病房。患者入院前1月余进食白薯后出现大便次数增多,最多5~6次/d,为不成形便,便中偶见鲜血,鲜血与大便不混、无粘液。不伴腹痛、腹胀、恶心、反酸、烧心等不适。既往史:囟门闭合时间晚,痔疮病史,10月余前因右侧大脑前动脉A1段动脉瘤(图1)行颅内动脉瘤栓塞术治疗,30年前行扁桃体切除术;家族史:母亲患结肠息肉,父亲及2个姐姐未做肠镜检查。体检:头围62 cm,左额角可见咖啡色斑块,面部、耳廓内外、唇周、牙龈、指端可见小丘疹,毛发稍稀疏(图2),足趾可见反甲,全身浅表淋巴结未触及明显肿大,左侧胸部可触及皮下肿块,大小约10 cm,质软,无压痛;心、肺、腹查体未见明显异常。

图1 右侧大脑前动脉A1段动脉瘤
图2 体格检查注:A:左侧额角咖啡色斑块;B:发量稀疏,额头多发小丘疹;C:口唇、牙龈小丘疹;D:指端小丘疹;E:耳后小丘疹
图3 箭头所指为左侧胸壁肌间隙内血管畸形
图4 胃镜检查可见食管弥漫结节样隆起,胃窦多发息肉样隆起注:A:食管黏膜全程弥漫结节隆起型改变,结节略发白,直径0.2~0.8 cm,局部连接成片,结节间黏膜相对正常;B:BLI下可见表面粗糙,可见轻度扩张血管;C:碘染后结节呈深染,结节表面可见点状发白;D:胃窦黏膜结节样及颗粒样改变
图5 肠镜检查结肠多发息肉注:A:回肠末端散在小息肉样隆起,表面光滑,色同周围;B:横结肠可见Ⅰs型息肉,大小约0.4 cm,表面光滑,色同周围;C:横结肠Ⅰsp型息肉,大小约0.3 cm;D:乙状结肠Ⅰsp型息肉,大小约0.6 cm×0.4cm,表面光滑,色红
图6 肠镜活检病理诊断注:A:息肉状黏膜慢性炎,表浅部隐窝腺体轻度扩张,见孤立的横纹肌组织,倾向错构瘤型息肉;B:倾向错构瘤型息肉;C:管状腺瘤
图7 小肠胶囊内镜检查注:A、B:小肠黏膜绒毛状,管腔通畅,可见多发息肉样隆起,山田Ⅰ~Ⅱ型,大小约0.4~0.7 cm,表面绒毛同周围黏膜,质地柔软;C、D:可见局部血管显露,血管畸形可能
图8 表皮颗粒层增厚,显著角化亢进,局灶上皮内陷,上皮脚延长两侧环抱,真皮浅层血管周围少量淋巴单核细胞浸润,符合肢端角化改变,伴角化棘皮瘤样增生
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