上消化道间叶源性肿瘤的内镜超声与病理诊断的对照研究

A comparative study of the diagnostic value of endoscopic ultrasonography with pathological features of upper gastrointestinal mesenchymal tumors

目的观察上消化道间叶源性肿瘤（GIMTs）的病理及免疫组化特点，对照研究其与内镜超声检查（EUS）诊断及其声像图特征间的关系，评价EUS在上消化道GIMTs诊治中的价值。方法收集72例上消化道GIMTs病理标本，其中手术标本34例，内镜下黏膜切除术（EMR）标本38例。采用光镜观察其病理特点，免疫组化染色法检测其CD117、CD34、α-平滑肌抗体（SMA）及S-100等的表达，判断其病理类型及良恶性状况，并与术前根据EUS声像图特征判定的起源层次及良恶性结果进行对照研究。结果72例上消化道GIMTs患者，经病理及免疫组化检查，37例（51．4％）诊断为间质瘤，其中恶性间质瘤21例（56．7％），平滑肌瘤34例（47．2％），神经鞘瘤1例（1．4％）。72例GIMTs中食管GIMTs占40例，EUS显示起源于黏膜肌层者38例，其中33例为平滑肌瘤，5例为间质瘤，起源于固有肌层者2例，均为间质瘤；胃GIMTs占32例，EUS显示起源于黏膜肌层2例，为胃间质瘤，30例起源于固有肌层，其中间质瘤28例，平滑肌瘤1例，神经鞘瘤1例。在上消化道间质瘤中，根据EUS声像图特征判断良恶性间质瘤的敏感性为81．0％，特异性达93．8％。结论上消化道GIMTs在胃以间质瘤为多见，EUS显示多起源于固有肌层；在食管以平滑肌瘤为多见，EUS显示多起源于黏膜肌层。根据EUS声像图特征判断上消化道间质瘤良恶性具有较高的敏感性和特异性，对GIMTs临床处置具有重要的指导作用。

Objective To study the pathological and immunohistochemical features of upper gastrointestinal mesenchymal tumors （GIMTs） and compare them with endoscopic uhrasonographie （EUS） characteristics so as to evaluate the diagnostic value of EUS in upper digestive tract GIMTs. Methods Seventy-two pathological specimens of upper digestive tract GIMTs （34 surgical specimens and 38 endoscopic mucosal resection （EMR） specimens ） were collected. The pathological features and the expression of CD117, CD34, SMA and S-100 were observed by immunohistochemical method with light microscope. The pathological types and characteristics were determined by pathologists and compared with the layer of origin and sonographic characteristics determined with preoperative EUS. Results In the 72 cases of upper digestive tract GIMTs, 37 cases were diagnosed as stromal tumor with pathological and immunohistochemical methods（51.4% ） ; 21 of them were malignant, accounting for 56. 7% of the stromal tumors. Thirty-four cases were diagnosed as leiomyoma （47.2%） and 1 case as schwannoma （ 1.4% ）. In the 72 GIMTs cases, 40 were esophageal GIMTs. EUS showed that 38 cases were originated from the muscularis mucosae layer; 33 of them were leimyoma and 5 stromal tumor. The 2 cases originating from the muscularis propria layer which were both stromal tumors. Thirty-two cases were gastric GIMTs, EUS showed that 2 cases originating from the muscularis mucosae layer were gastric stromal tumor. Of the 30 cases originating from the muscularis propria layer, 28 cases were stromal tumor, 1 case was leiomyoma and 1 case was sehwannoma. The sensitivity and the specificity of EUS in distinguishing benign and malignant stromal tumors according to sonographic characteristics were 81.0% and 93.8% respectively. Conclusion Stromal tumor is morecommon in stomach mesenchymal neoplasms and is more often originated from the muscularis propria layer in EUS; leiomyoma is more common in esophagus and is more often originated from the muscularis mucosae layer. The diagnostic sensitivity and specificity of EUS are high in distinguishing benign and malignant character of upper digestive tract GIMTs. EUS plays an important role in guiding the clinical management of upper digestive tract GIMTs.