食管上皮源性恶性肿瘤误诊病例的内镜超声及组织病理学特点分析  

Endoscopic ultrasonography and histopathological analysis of misdiagnosed cases of esophageal epithelial malignant tumors

作　　者：石亮亮[1] 张妮娜 周林 沈永华[1] 杨天[1] 邹晓平[1] Shi Liangliang;Zhang Nina;Zhou Lin;Shen Yonghua;Yang Tian;Zou Xiaoping(Department of Gastroenterology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,南京210008

出　　处：《中华消化内镜杂志》2022年第9期743-746,共4页Chinese Journal of Digestive Endoscopy

摘　　要：为了分析误诊为食管黏膜下肿瘤的食管上皮源性恶性肿瘤的内镜超声及组织病理学特点,回顾性分析2012年1月—2020年12月在南京鼓楼医院术前诊断为食管黏膜下肿瘤但术后病理证实为食管上皮源性恶性肿瘤的患者资料,记录患者的年龄、性别、病变大小、病变部位、超声下病变起源、病变回声、内镜治疗方式以及术后病理等临床资料。11例患者中男9例、女2例,年龄(65.5±6.2)岁,9例病变长径≤2 cm,8例病变位于胸中段食管。11例患者中10例术前行内镜超声检查,病变起源于黏膜下层6例、固有肌层2例、黏膜肌层2例,病变回声9例为低回声改变,仅1例为等回声病变。11例患者中3例行内镜黏膜切除术,6例行内镜黏膜下剥离术,2例行隧道法内镜黏膜下肿物切除术。组织病理学类型包括3例中低分化鳞癌,3例基底细胞样鳞癌,2例腺样囊性癌(其中1例为腺样囊性癌碰撞鳞癌),2例腺癌,1例食管肉瘤样癌合并基底细胞样鳞癌。食管上皮源性恶性肿瘤内镜下表现为黏膜下隆起极为罕见,内镜超声有助于鉴别诊断,诊断性治疗可明确诊断。To analyze the endoscopic ultrasonography(EUS)and histopathological features of esophageal epithelial malignant tumors misdiagnosed as esophageal submucosal tumors(SMT),data of patients diagnosed as having esophageal SMT preoperatively but confirmed as esophageal epithelial malignant tumor by pathology after operation in Nanjing Drum Tower Hospital from January 2012 to December 2020 were retrospectively analyzed,and the clinical data including age,gender,size and location of the lesion,origin and echo of the lesion under EUS,endoscopic treatment and postoperative pathology were recorded.Among the 11 patients,there were 9 males and 2 females,aged(65.5±6.2)years.The length diameter of 9 lesions was≤2 cm,and 8 lesions were located in the middle thoracic esophagus.Among the 11 patients,10 underwent EUS before operation.The lesions originated from submucosa in 6 cases,muscularis propria in 2 cases and muscularis mucosa in 2 cases.The echo of the lesions was hypoechoic in 9 cases and isoechoic in only 1 case.Of the 11 patients,3 underwent endoscopic mucosal resection,6 underwent endoscopic submucosal dissection,and 2 underwent submucosal tunneling endoscopic resection.The histopathological types included 3 cases of moderately to poorly differentiated squamous cell carcinoma,3 cases of basaloid squamous cell carcinoma,2 cases of adenoid cystic carcinoma(including 1 case of adenoid cystic carcinoma colliding with squamous cell carcinoma),2 cases of adenocarcinoma,and 1 case of esophageal sarcomatoid carcinoma with basaloid squamous cell carcinoma.Endoscopic manifestations of submucosal eminence in esophageal epithelial malignant tumors are extremely rare.EUS is helpful for differential diagnosis,and diagnostic treatment can make a definite diagnosis.

关 键 词：误诊 食管肿瘤 黏膜下肿瘤 内镜超声检查 组织病理 

分 类 号：R735.1[医药卫生—肿瘤]