BorrmannⅣ型胃癌微探头超声图像特征

Image features of miniprobe endoscopic ultrasonography for Borrmann Ⅳ type gastric cancer

目的探讨BorrmannⅣ型胃癌的微探头超声(MPEUS)图像特征。方法对胃镜检查疑似BorrmannⅣ型胃癌的28例患者同时进行MPEUS检查及MPEUS指导下的挖掘样活检。结果病理证实胃癌19例,淋巴瘤5例,炎性胃壁增厚4例。MPEUS检查:19例胃癌病变处胃壁全层增厚,其中11例印戒细胞癌病变处黏膜表层回声增强,后方声衰减明显,动态观察:胃壁僵硬,运动消失;5例胃淋巴瘤病变处胃壁黏膜和黏膜下层分界不清,明显增厚,回声偏低、均匀,肌层结构、回声正常,浆膜层显示清晰、完整;4例炎性胃壁增厚病变处黏膜及黏膜下层分界不清,明显增厚,回声增强、不均匀,内可见散在的小片状低回声区,肌层结构、回声正常,浆膜层显示清晰、完整,动态观察:胃壁运动基本正常。结论BorrmannⅣ型胃癌的MPEUS图像特征为胃壁全层增厚,黏膜及黏膜下层结构不清,回声低、不均匀;肌层明显增厚;动态观察胃壁僵硬、蠕动消失。

Objective To explore the image features of miniprobe endoscopic ultrasonography (MPEUS) for Borrmann Ⅳ type gastric cancer. Methods Twenty-eight cases of suspected Borrmann Ⅳ type gastric cancer were performed miniprobe EUS and miniprobe EUS-guided deep biopsy as well as conventional gastroscopy. Results Pathology of the 28 cases revealed 19 cases of gastric cancer, 5 cases of lymphoma, and 4 cases of inflammatory thickening of gastric wall. With miniprobe EUS, lesions of gastic cancer showed thickened gastric wall of all layers, blurred demarcation and slight thickening of mucosa and submucosa which was hypoechoic and heteroechoic, and marked thichened muscular layer. Of 19 cases of gastric cancer, 11 cases of signet cell cancer were hyperechoic in the superficial mucosa with marked attenuation,and dynamic observation detected stiffened gastric wall and loss of movement of gastric wall. Lesions of lymphoma showed blurred demarcation and marked thickening of mucosa and submucosa which was hypoechoic and homoechoic, with normal muscular structure and echo as well and clear and intact serosa. Inflammatory thickening of gastric wall showed blurred demarcation and marked thickening of mucosa and submucosa which was hyperechoic and heteroechoic, with normal muscular structure and echo as well as clear and intact serosa, and dynamic observation detected almost normal movement of gastric wall. Conclusion Image features of Borrmann Ⅳ type gastric cancer include thickening of all layers of gastric wall, blurred structure of mucosa and submucosa, hypoechoic and heteroechoic, markedly thickened muscular layer, stiffened gastric wall and loss of movement of gastric wall under dynamic observation.