内镜治疗上消化道颗粒细胞瘤5例临床分析

Granular cell tumors of upper digestive tract: a clinicopathologic analysis of 5 cases

目的探讨上消化道颗粒细胞瘤的内镜及临床特点。方法回顾性分析我院2007年-2011年间经内镜诊断和治疗的5例上消化道颗粒细胞瘤的临床、内镜、病理及免疫组织化学等特征及治疗。结果 4例位于食管,1例位于贲门,病灶直径0.5～2.0cm不等。超声内镜提示肿物位于黏膜层至黏膜下层,呈低回声。2例病灶均行黏膜切除术(EMR)治疗,3例病灶均行内镜下黏膜剥离术(ESD)治疗,病变切除完整,术中有1例发生出血,行热活检钳紧急反复止血后未再出血,无穿孔等并发症发生。术后病理示肿瘤细胞排列紧密,呈巢状或条索状,细胞核小,胞质丰富,嗜酸性颗粒状,瘤细胞间仅见少量纤维结缔组织分隔。免疫组化本组5例肿瘤细胞S-100均弥漫强(+),NSE(+),CD68(+),SMA、CK和CD117均(-)。术后随访6个月～2年,患者无复发及转移。结论上消化道颗粒细胞瘤少见,确诊依赖于病理形态特点及免疫组化标记,内镜下治疗是安全,有效的。

Objective To explore the endoscopic and clinical characteristics of granular cell tumors （GCTs） in up- per digestive tract. Methods The clinical data, endoscopic features, immunohistochemical profiles and therapeutics were studied retrospectively in five cases of granular cell tumors in upper digestive tract. Results Five new cases （ 1 man, 4 women; 4 esophagus, 1 preventriculus; median age 52 years） were registered. The lesion size ranged from 0.5 to 2.0 cm. The lesions examined by endoscopic ultrasounography （EUS） were low echo-level and situated in the mucosa and submucosa. Endoscopic mucosal resection （EMR） was used in 2 cases, and endoscopic submucosal dissection （ESD） was used in 3 cases, except for operative bleeding in 1 patient, no other complications were observed. Micro- scopically, the tumor cells of digestive tract GCTs were arranged in nests or sheets with small nuclei and full of eosino- philic cytoplasm. The cell nests were separated by slender fibrous connective tissue. Immunohistochemical stain showed that the tumor cells were positive for S-100 protein, NSE and CD68, but negative for SMA, CK and CD117. Recurrence or metastasis was not detected in all five cases during 6 to 24 months of follow-up. Conclusion GCTs in the upper di- gestive tract were rare, its definite diagnosis should rely on the histopathological and immunohistochemical features. En- doscope treatment is an effective and safe procedure.