食管碰撞瘤临床影像及病理分析

Collision tumor of Esophagus: a clinicopathologic analysis

目的探讨食管碰撞瘤的临床病理特点,提高对本病的认识。方法对8例食管碰撞瘤进行临床及病理资料分析,并复习文献。结果 8例患者,年龄49~69岁,中位年龄66岁。5例伴有不同程度的进行性吞咽困难或进食阻挡感,3例伴有胸骨后疼痛或胸骨后不适。8例中,病变位于中段食管6例,下段食管2例。X线上消化道钡餐7例显示食管单发性占位性病变,1例未发现明显肿瘤征象;其中6例同时进行了CT检查,4例考虑食管癌,2例发现食管壁僵硬增厚,建议结合胃镜检查;8例患者均行内镜检查,3例镜下见隆起型肿物,5例发现黏膜溃疡形成,6例镜下考虑食管癌,2例诊断食管占位。8例术前活检病理均诊断为鳞状细胞癌。8例均行食管肿瘤切除手术。显微镜观察,8例肿瘤均由两种成分组成,彼此界限清楚,各自弥漫性生长。1例为神经内分泌癌与多形性平滑肌肉瘤碰撞瘤,7例为神经内分泌癌与鳞状细胞癌碰撞瘤。结论食管碰撞瘤比较罕见,临床症状、内镜检查及影像学检查均缺乏特异性,术前诊断困难,确诊需靠术后病理检查并结合免疫组化染色综合判断。

Objective To study the clinical pathological characteristics of esophageal collision tumor and to improve the knowledge of esophageal collision tumor. Methods Eight cases of esophageal collision tumors were studied by clinical data analysis,HE staining and immunohistochemistry staining,with review of the related literature. Results Ages of eight cases rangee from 49 to 69. Five patients were accompanied with different degree of progressive dysphagia or eating barrier,3 cases with retrosternal pain and discomfort after the sternum. In 8 cases,the lesions located in the middle section of esophagus in 6 cases and in lower esophagus in 2 cases. 7 cases showed esophageal solitary lesions by X-ray and one case had no tumor signs. 6 cases were examined by CT scan simultaneously,4 of them were considered as esophageal cancer and 2 were found rigidity and thickening wall. Endoscopy was performed in all 8 patients,3 cases were found with protrude type tumor,5 cases with mucosa ulcer; 6 cases were diagnosed as esophageal cancer,2 cases with the diagnosis of esophageal occupying. 8 cases of squamous cell carcinoma were diagnosed before operation. All of them underwent resection of esophageal cancer. In microspsopy,all 8 cases of tumors were composed of two components. 1 case of neuroendocrine carcinoma presented with pleomorphic leiomyosarcoma collision tumor,7cases were neuroendocrine carcinoma and squamous cell carcinoma of collision tumor. Conclusion Esophageal collision tumor is very rare. Clinical symptoms,endoscopic examination and imaging are all lack of specificity. It is very diffcult to make preoperative diagnosis is diagnosis was made by postoperative pathological examination and combined with immunohistochemical staining.