食管上段黏膜下腺导管腺瘤1例并文献复习  

Upper esophageal submucosal gland duct adenoma:A case report and literature review

作　　者：孟琳 贾旭春 赵芯 李增山 张丽英 MENG Lin;JIA Xuchun;ZHAO Xin;LI Zengshan;ZHANG Liying(Department of Pathology,First Affiliated Hospital,Air Force Military Medical University,Xi’an 710032;Department of Pathology,Baoji Central Hospital,Baoji Shaanxi 721000;Department of Gastroenterology,First Affiliated Hospital,Air Force Military Medical University,Xi’an 710032,China)

机构地区：[1]空军军医大学第一附属医院病理科,西安710032 [2]宝鸡市中心医院病理科,陕西宝鸡721000 [3]空军军医大学第一附属医院消化内科,西安710032

出　　处：《临床与病理杂志》2024年第12期1735-1741,共7页Journal of Clinical and Pathological Research

摘　　要：食管黏膜下腺导管腺瘤(esophageal submucosal gland duct adenoma,ESGDA)起源于食管黏膜下腺(submucosal gland,SMG),好发于食管下段,是食管罕见的良性肿瘤。其活检小标本在形态学上可因密集排列的不规则腺体形成间质减少的假象,且管腔内易见细胞坏死碎屑和炎性渗出物,易被误诊为腺癌。本文报道1例曾于外院诊断为“食管腺癌”的食管上段黏膜下腺导管腺瘤的64岁女性患者,胸骨下隐痛数月,超声显示病变位于黏膜层,呈中高回声改变;内镜示距门齿23 cm处可见一0.4 cm×0.4 cm扁平黏膜隆起,采用内镜下黏膜切除术治疗;镜下见肿瘤性腺体,腺腔不规则,腔内见红染分泌物,腺体由双层上皮构成,细胞呈单层或多层排列,细胞形态温和,免疫组织化学染色示细胞角蛋白(cytokeratin,CK)5/6、CK7、CK8/18、P40、P63阳性,提示为腺上皮及肌上皮,肿瘤无癌性促纤维组织增生性间质,可见少量淋巴细胞及嗜酸性粒细胞浸润。对该病的诊断需重点关注腺体上皮的构成成分、细胞形态及间质改变,并辅助免疫组织化学染色印证分化方向,以避免误诊为腺癌后行外科手术治疗。Esophageal submucosal gland duct adenoma(ESGDA)is a rare benign tumor originating from the submucosal gland(SMG)of the esophagus,most commonly occurring in the lower esophagus.Due to the dense arrangement of irregular glands and reduced stromal appearance in small biopsy specimens,along with necrotic cellular debris and inflammatory exudate within the lumina,ESGDA can be easily misdiagnosed as adenocarcinoma.This paper reports a case of ESGDA located in the upper esophagus in a 64-year-old female who was previously misdiagnosed with esophageal adenocarcinoma at another hospital.The patient presented with retrosternal discomfort for several months.Ultrasonography revealed a mucosal lesion with hyperechoic characteristics.Endoscopy showed a 0.4 cm×0.4 cm flat mucosal elevation at 23 cm from the incisor line,which was treated with endoscopic mucosal resection.Histologically,the lesion exhibited irregular glandular structures containing eosinophilic secretions,composed of a bilayered epithelium with monolayer or multilayer cell arrangement and bland cytologic features.Immunohistochemically,tumor cells were positive for cytokeratin(CK)5/6,CK7,CK8/18,P40,and P63,indicating both glandular epithelium and myoepithelial differentiation.There was no desmoplastic stromal reaction suggestive of malignancy,though sparse lymphocytic and eosinophilic infiltrates were present.Diagnosis of ESGDA requires careful evaluation of epithelial composition,cytologic features,and stromal context,with immunohistochemical staining aiding in determining differentiation,in order to avoid misdiagnosis and unnecessary surgical intervention.

关 键 词：食管上段 食管黏膜下腺导管腺瘤 食管腺癌 细胞角蛋白 免疫组织化学染色 

分 类 号：R735.1[医药卫生—肿瘤]