食管间质瘤与平滑肌肿瘤的临床鉴别及治疗

Differential Diagnosis and Treatment of Esophageal Stromal Tumors and Smooth Muscle Tumors

背景与目的:食管间质瘤与平滑肌肿瘤虽然具有不同的病理学特征,但是临床上不易鉴别。本研究比较食管间质瘤和平滑肌肿瘤的临床特征,并探讨其治疗原则。方法:用免疫组织化学法检测原诊断为食管平滑肌(肉)瘤20例和间质瘤1例肿瘤组织中CD117和CD34等一组抗体表达,结合病理学形态表现和临床表现进行分析,并总结各自的治疗原则及疗效。结果:16例原诊断为食管平滑肌瘤有5例CD117(+),按照间质瘤评定标准,均为非高度侵袭危险性食管间质瘤,余11例CD117(-);1例原间质瘤CD117(+)和CD34(+),为高度侵袭危险性食管间质瘤;4例食管平滑肌肉瘤CD117(-)和CD34(-)。食管非高度侵袭危险性间质瘤和平滑肌瘤的病理学形态表现、临床表现、治疗方法和预后没有明显差异;食管高度侵袭危险性间质瘤和平滑肌肉瘤的病理学形态表现、临床表现、治疗方法和预后也没有明显差异。结论:病理学形态表现和临床表现无法区分食管间质瘤和平滑肌肿瘤,CD117等抗体的免疫组织化学法检测是区分食管间质瘤和平滑肌肿瘤必不可少的手段。食管非高度侵袭危险性间质瘤和平滑肌瘤局部切除术或部分食管切除术可以达到根治,预后良好;高度侵袭危险性食管间质瘤和平滑肌肉瘤需行食管部分切除术。

BACKGROUND ＆ OBJECTIVE. Esophageal stromal tumors and smooth muscle tumors are not easy to be distinguished in clinic though they have different pathologic features. This study was to compare the clinicopathologic features of esophageal stromal tumors and smooth muscle tumors, and discuss their treatments. METHODS： The expression of CDl17 and CD34 in 16 specimens of primarily diagnosed esophageal leiomyoma, 4 specimens of esophageal leiomyosarcoma, and 1 specimen of stromal tumor was detected by immunohistochemistry. The clinicopathologic features of the patients were analyzed, and the treatment principles and curative efficacies were summarized. RESULTS： Of the 16 cases of primarily diagnosed esophageal leiomyoma, 5 were CDl17（＋） and finally diagnosed as. nonhigh aggressive fatal stromal tumor according to the assessment criteria of stromal tumors; 11 were CDl17（-）. The stromal tumor was CDl17（＋） and CD34（＋）, and diagnosed as high aggressive fatal stromal tumor. The 4 cases of primarily diagnosed esophageal leiomyosarcoma were CD117（-） and CD34 （-）. There was no obvious difference in clinicopathologic manifestations, treatment and prognosis between esophageal non-high aggressive fatal stromal tumor and leiomyoma, and between esophageal high aggressive fatal stromal tumor and leiomyosarcoma. CONCLUSIONS： Esophageal stromal tumors and smooth muscle tumors can not be distinguished with clinicopathologic exhibitions. The immunohistochemical examination of antibody CDl17 is necessary for identifying them. Lumpectomy or esophageal partial resection is enough for esophageal non-high aggressive fatal stromal tumor and leiomyoma. Esophageal partial resection is necessary for esophageal high aggressive fatal stromal tumor and leiomyosarcoma.