消化系炎性纤维性息肉的临床、内镜及病理特征  

Clinical, endoscopic and pathologic features of inflammatory fibroid polyps of the digestive system

作　　者：项一宁[1] 许良璧[2] 

机构地区：[1]贵阳医学院病理学教研室,贵州省贵阳市550004 [2]贵阳医学院附属医院消化内镜中心,贵州省贵阳市550004

出　　处：《世界华人消化杂志》2015年第9期1514-1520,共7页World Chinese Journal of Digestology

摘　　要：目的:探讨消化系炎性纤维性息肉(inflammatory fibroid polyp,IFP)的临床、内镜及病理的特征及鉴别诊断.方法:收集16例消化系的IFP进行临床、内镜、超声内镜、病理组织学形态观察.采用免疫组织化学方法检测肿瘤表达Vimentin、CD34、CD117、DOG-1(discovered on GIST-1)、肌动蛋白(smooth muscle actin,S M A)、S-100、Desmin及细胞角蛋白(cytokeratin,CK)的情况.结果:消化系的IFP主要发生在40-60岁成年人(56.25%),女性略占优势.发生的部位依次为胃(56.25%)、小肠(25.0%)和结肠(18.75%),胃窦是最常见的发病部位.内镜下主要表现为息肉、黏膜下隆起及新生物样隆起.超声内镜下表现为第三层或第二层的低回声,但未见进入第四层.与周围组织界限欠清.病理组织学表现为IFP的病变主体在黏膜下层,可以侵及黏膜层,但不会侵入肌层.IFP主要有3种成分组成:纤维母细胞样梭形细胞、小血管及嗜酸性粒细胞.特征性的病理表现为:恒定出现的嗜酸性粒细胞及纤维母细胞样梭形细胞围绕血管呈洋葱皮样或同心圆状排列.免疫组织化学:Vimentin及C D34的表达率分别为100%及87.5%.治疗方法为外科手术治疗和内镜黏膜切除(endoscopic mucosal resection,EMR)/内镜黏膜下剥离(endoscopic submucosal dissection,ESD).结论:消化系的IFP发生年龄、部位有一定的规律.内镜和超声内镜下的表现有一定特征.特征性的病理组织学和免疫组织化学表现能明确诊断IFP,并且能帮助鉴别诊断发生在黏膜下层的肿瘤.AIM： To investigate the clinical, endoscopic and pathologic features, as well as differential diagnosis of gastrointestinal inflammatory fibroid polys（IFPs）. METHODS： The clinical data for 16 cases of IFPs were analyzed. The findings of endoscopy,endoscopic ultrasound, and histopathology were reviewed. Immunohistochemistry studies for Vimentin, CD34, CD117, discovered on GIST-1（DOG-1）, smooth muscle actin（SMA）, S-100, and Desmin and cytokeratin（CK） were performed. RESULTS： IFPs were mainly found in adults aged 40-60 years（56.25%）, slightly more frequently in women. IFPs occurred mainly in the stomach（56.25%）, small bowel（25%）, and colon（18.75%）, with the antrum being the most common place. The tumor might present as a polyp, submucosal mass or neoplasm-like mass. Endoscopic ultrasound showed hypoechoic lesions in the third or the second sonographic layer of the gastric wall but without involving the fourth layer, and the margin was poorly circumscribed. Histopathology showed that the tumor was mainly located in the submucosa and could invade the mucosa, but not the muscle layer. Microscopically, the main tumor components were fibroblast-like spindle cells, vascular and polymorphic inflammatory cells, usually dominant by eosinophils. The specific pathologic findings included eosinophils and concentric fibroblast-like spindle cells with an ‘onion-skin＇-like appearance around vessels. Immunohistochemical staining of the spindle cells of IFPs showed 100% positivity for vimentin and 87.5% positivity for CD34. Treatments for IFPs included surgery and endoscopic submucosal dissection（ESD） or endoscopic mucosal resection（EMR）. CONCLUSION： There are similar patterns for patient age and tumor location in IFPs.Endoscopy and endoscopic ultrasound can provide specific findings. The histopathological and immunohistochemical characteristics are useful for accurately diagnosing IFPs and differential diagnosis of the tumors occurring in the submucosa.

关 键 词：炎性纤维性息肉 肿瘤 内镜 超声内镜 组织病理学 免疫组织化学 

分 类 号：R57[医药卫生—消化系统]