内镜粘膜活检组织的病理诊断思路及陷阱

The diagnostic thinking and trap in the diagnosis of endoscopic mucosal biopsy tissue

目的探讨消化内镜粘膜活检组织的病理诊断思路及其陷阱,提高消化内镜粘膜活检组织的病理诊断准确率。方法回顾性分析17737例消化内镜粘膜活检组织的常规HE染色及部分病例的免疫组化染色结果,分析其病理诊断中的陷进及注意事项。结果 17737例消化内镜粘膜组织中,经常规HE染色而明确诊断的病例有16786例,另有951例经常规HE染色观察下无法确诊的病例,其镜下形态多为无法判断组织来源的异型细胞团、肿瘤组织过少、组织挤压严重、坏死背景严重或HE切片染色质量欠佳。经过再次切片、染色明确诊断652例,其中恶性肿瘤214例;经过免疫组织化学或组织化学染色后明确诊断299例,其中恶性肿瘤159例。结论在诊断消化内镜粘膜活检组织的过程中,病理医师必须认识到存在的诊断陷阱,一定要结合内镜下检查,特殊情况下,需要再次切片、染色或进行免疫组化染色辅助诊断,以避免漏诊、误诊。

Objective To explore the diagnostic thinking and trap in the pathological diagnosis of endoscopic mucosal biopsy tissue.Methods The HE and immunohistochemical staining results of 17737 cases endoscopic mucosal biopsy tissues specimens were retrospectively analyzed.Results In the 17737 cases of digestive endoscopic mucosal tissue,16786 cases were accurately diagnosed by the conventional HE staining,and another 951 cases cannot be diagnosed by the conventional HE staining for tumor tissue too little,severe tissue extrusion and serious necrosis background.After resection and staining,652 cases were diagnosed,including 214 malignant tumors.After immunohistochemistry or histochemical staining,299 cases were diagnosed,of which 159 were malignant.Conclusion In the process of pathological diagnosis for digestive endoscopic mucosal biopsy tissues,physicians must be aware of existing diagnosis trap.In order to avoid missed diagnosis and misdiagnosis,it is necessary to combined with endoscopic examination or section and immunohistochemical stain.