CAJ | 학술논문

目的探讨食管间叶源性肿瘤(EMT)的临床病理、胃镜、超声内镜和免疫组织化学特征.方法收集经由胃镜下活组织检查、内镜下治疗或外科手术获取组织并经病理和免疫组织化学法确诊的98例EMT患者的临床资料,对其临床病理、胃镜、超声内镜和免疫组织化学特征进行回顾性分析,并与其他食管黏膜下肿瘤相鉴别.结果 98例EMT中平滑肌瘤77例,食管胃肠道间质瘤(GIST) 15例(其中高危1例),脂肪瘤4例,平滑肌母细胞瘤1例,神经鞘瘤1例.GIST组年龄高于平滑肌瘤组,这两组都以男性较多.吞咽梗阻是EMT最常见的症状,呕血黑便少见,有别于胃肠道间叶源性肿瘤.胃镜下EMT多表现为凸入腔内的黏膜下病变,仅1例食管GIST向腔外生长.超声内镜下GIST、平滑肌瘤和神经鞘瘤表现为来源于固有肌层或黏膜肌层的低回声团块.脂肪瘤表现为来自黏膜下层的高回声团块.GIST、平滑肌瘤和神经鞘瘤病理主要表现为梭形细胞,部分GIST为上皮样细胞.CD117和CD34在GIST中有较高的表达率,SMA和Desmin在平滑肌瘤中有较高的表达率,神经鞘瘤仅S-100阳性,其他黏膜下肿瘤如食管囊肿、食管结核、食管癌肉瘤和部分食管鳞状细胞癌易被误诊为食管EMT.结论食管平滑肌瘤是最常见的EMT,其次为GIST.超声内镜对EMT诊断有意义,但不能精确地辨别GIST平滑肌瘤和神经鞘瘤,确诊还需免疫组织化学检测.
목적 탐토식관간협원성종류(EMT)적림상병리、위경、초성내경화면역조직화학특정.방법 수집경유위경하활조직검사、내경하치료혹외과수술획취조직병경병리화면역조직화학법학진적98례EMT환자적림상자료,대기림상병리、위경、초성내경화면역조직화학특정진행회고성분석,병여기타식관점막하종류상감별.결과 98례EMT중평활기류77례,식관위장도간질류(GIST) 15례(기중고위1례),지방류4례,평활기모세포류1례,신경초류1례.GIST조년령고우평활기류조,저량조도이남성교다.탄인경조시EMT최상견적증상,구혈흑편소견,유별우위장도간협원성종류.위경하EMT다표현위철입강내적점막하병변,부1례식관GIST향강외생장.초성내경하GIST、평활기류화신경초류표현위래원우고유기층혹점막기층적저회성단괴.지방류표현위래자점막하층적고회성단괴.GIST、평활기류화신경초류병리주요표현위사형세포,부분GIST위상피양세포.CD117화CD34재GIST중유교고적표체솔,SMA화Desmin재평활기류중유교고적표체솔,신경초류부S-100양성,기타점막하종류여식관낭종、식관결핵、식관암육류화부분식관린상세포암역피오진위식관EMT.결론 식관평활기류시최상견적EMT,기차위GIST.초성내경대EMT진단유의의,단불능정학지변별GIST평활기류화신경초류,학진환수면역조직화학검측.
Objective To explore the features of clinicopathology,gastroscopy,endoscopic ultrasonography (EUS) and immunohistochemistry of esophageal mesenchymal tumors (EMT).Methods The clinical data of 98 cases of EMT patients who underwent endoscopic biopsy,endoscopic treatment or surgery and were diagnosed according to pathological and immunohistochemistry examination were collected.The clinicopathologic characteristics,endoscopy,EUS and immunohistochemistry of these cases were retrospectively analyzed,and differentiated from other submucosal tumor.Results Among the 98 cases of EMT,there were 77 leiomyomas (LM),15 gastrointestinal stromal tumors (GIST),four lipomas,one leiomyoblastoma and one schwannoma.The age of GIST group were older than that of LM group,and most were male patients predominated in these two groups.Dysphagia was the most common symptom of EMT.Gastrointestinal bleeding was rare,which was different from other gastrointestinal mesenchymal tumors.Under endoscopy,the appearances of EMT were similar,as submucosal protuberant lesions.One esophageal GIST was extraluminal lesion.Under EUS,LM,GIST and schwannoma showed low echo images originated from the muscularis propria or muscularis mucosa.Lipomas showed high echo images originated from submucosa.Pathological examination indicated that main cell type of LM and schwannoma was spindle cell,part of GIST was epitheloid cell type.The expressions of CD117 and CD34 were high in GIST,the expressions of SMA and Desmin were high in LM.S-100 was expressed in schwannoma.Other submucosal tumors,such as esophageal cyst,esophageal tuberculosis,esophageal carcinosarcoma,and some esophageal squamous carcinoma were easily misdiagnosed as EMT.Conclusions Esophageal LM is the most common EMT,followed by GIST.EUS is helpful in EMT diagnosis,however it can not accurately distinguish GIST,LM or schwannoma.