食管肉瘤样癌的影像病理对照分析  

Imaging and pathological analyses of esophageal sarcomatoid carcinoma

作　　者：杨建涛 石磊[1] 谢铁明[1] 江海涛[1] YANG Jiantao;SHI Lei;XIE Tieming;JIANG Haitao(Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, P.R.China)

机构地区：[1]浙江省肿瘤医院放射科

出　　处：《医学影像学杂志》2019年第8期1329-1333,共5页Journal of Medical Imaging

基　　金：浙江省科学技术厅2015年度省级公益性技术应用研究计划项目(编号:2015KYB063)

摘　　要：目的 分析食管肉瘤样癌的影像表现,并与病理对照,以加深对该疾病认识。方法 回顾性分析18例经病理证实的食管肉瘤样癌患者CT及食管造影特征,并与术后病理肿瘤浸润深度和淋巴结转移情况进行对比分析。结果 9例术前进行食管造影检查,6例(6/9)表现为腔内型病变,3例(3/9)为髓质型病变。根据CT表现可将食管肉瘤样癌分为腔内肿块型和管壁增厚型。腔内肿块型6例,表现为管腔内边缘光整或浅分叶状肿块,壁外脂肪间隙清楚,均未见肿大淋巴结;12例为管壁增厚型,10例累及管壁全周;9例(9/12)壁外脂肪间隙模糊,8例(8/12)见肿大淋巴结。病理检查腔内肿块型多侵犯粘膜下层(4/6),仅1例(1/6)淋巴结转移。管壁增厚型7例浸润至外膜,5例淋巴结转移(5/8)。结论食管肉瘤样癌腔内肿块型以管腔内占位为主要表现,周围浸润程度轻和淋巴结转移率低;管壁增厚型,浸润外膜概率及淋巴结转移率明显高于腔内肿块型,预后较差。Objective To analyze and compare imaging and pathological characteristics of esophageal sarcomatoid carcinoma and to improve the understanding of it. Methods We retrospectively analyzed 18 patients pathologically confirmed esophageal sarcomatoid carcinoma on imaging and pathological characteristic, and summarized the connection between the imaging and pathological characteristic. Results 9 patients underwent esophageal angiography, 6(6/9) patients showed endoluminal lesion type, 3 cases showed medullary type. Based on the CT findings, the patients were divided into two types, which included endoluminal mass type (6) and luminal wall thicken type (12). 6 endoluminal mass type patients showed intraluminal mass with clear margin and mild lobulation, peritumoral fat space was clear, without swollen lymph node. 12 cases manifested as luminal wall thicken type, 10 cases infiltrated the whole circle of the esophagus. Extraluminal fat space was obscure in 9 cases (9/12), 8 cases suffered from lymphadenopathy. Pathology examination showed that most of the intraluminal mass type tumor invaded the submucosa layer (4/6), only 1 case presented with lymph node metastasis (1/6). Infiltrated luminal wall thicken type showed 7 cases infiltrated the whole layer and extra membrane of the esophagus, 5(5/8) cases confirmed with lymph node metastasis. Conclusion Esophagus sarcomatoid carcinoma manifests as endoluminal mass type that shows intraluminal polypoid mass, larger masses with unmatched lower tumor infiltration depth degree and low lymph node metastasis rate, esophageal wall infiltrated thicken type suffered from higher infiltration depth and lymph node metastasis rate.

关 键 词：食管肿瘤 肉瘤样癌 癌肉瘤 体层摄影术 X线计算机 

分 类 号：R735.1[医药卫生—肿瘤] R445[医药卫生—临床医学]