内镜超声引导下细针穿刺结合免疫组织化学鉴别上消化道固有肌层肿瘤  

Differential diagnosis of tumors in upper GI muscularis propria by EUS guided fine needle aspiration and immunohistochemical evaluation

作　　者：孙思予[1] 吕庆杰[2] 秦波 王占辉 

机构地区：[1]中国医科大学附属第二医院内镜中心,沈阳110004 [2]中国医科大学附属第二医院病理科,沈阳110004 [3]抚顺市第三人民医院 [4]昌图县第一人民医院

出　　处：《中华消化内镜杂志》2005年第5期312-314,共3页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜超声引导下细针穿刺结合免疫组织化学检查在鉴别上消化道固有肌层肿瘤起源中的作用。方法选择经内镜发现并由内镜超声检查证实直径大于25 mm的上消化道固有肌层病变患者35例,内镜超声检查明确病变的大小、形态、位置,并观察有无周围脏器转移。在内镜超声导引下对病变行细针穿刺,对取材分别进行HE、CD117,CD34和肌动蛋白(SMA)染色。结果35例患者中,31例患者取得了足够的组织,经免疫组化染色,诊断为间质瘤21例,平滑肌瘤10 例。与术后诊断比较超声内镜结合免疫组织化学检查的敏感性为88.6%,特异性为100%。无一例患者出现不良反应。结论内镜超声引导下细针穿刺结合免疫组织化学检查是鉴别上消化道固有肌层肿瘤安全有效的方法。Objective It is difficult to differentiate tumors in upper GI muscularis proporia, such as GI stromal tumors （GISTs） , leiomyomas and schwannomas. We performed EUS guided fine needle aspirations （FNA） and immunohistochemical evaluation of these tumors in upper GI muscularis proporia. Methods We selected 35 Patients with lesions in upper GI muscularis proporia by EGD and EUS. We assessed the shape, size, and position of the lesions and the status of metastasis. After excluding blood vessel between the lesions and the fine needle, EUS FNA were carried out and immunohistochemical staining for CD-117 （ckit） , CD34 and smooth muscle actin （SMA） was performed. Results All patients were performed EUS FNA and enough specimens were obtained in 31 patients. The other 4 failed, although we tried it for several times. Among the 31 patients, Cytology and immunohistochemisty demonstrated 21 GISTs and 10 leiomyomas. All the results were evaluated by surgery. The sensitivity is 88.6% ,and the speciality is 100%. No complication occurred. Conclusion EUS-guided FNA and immunohistochemical evaluation is an accurate method for diferential diagnosis of tumors in upper GI muscularis propria.

关 键 词：内镜超声检查 细针穿刺活检 胃肠间质瘤 免疫组织化学 免疫组织化学检查 超声引导下 上消化道 细针穿刺 固有肌层 化学鉴别 

分 类 号：R735[医药卫生—肿瘤]