食管平滑肌瘤误诊病例分析

Analysis of misdiagnosis of esophageal leiomyoma

目的 分析食管平滑肌瘤误诊原因，提高术前诊断水平。方法 回顾性分析16年间共20例术前诊断为食管平滑肌瘤而术后证实为误诊的病例。男11例（55%），女9例（45%），年龄13-71岁，平均（45.9±16.4）岁，其中梗阻症状者12例（60%）。行CT检查9例（45%），其中增强CT 4例（20%）。结果 误诊患者中食管外病变5例：4例食管旁淋巴结结核，1例淋巴结增生；良性间质病变8例：神经鞘瘤、包涵囊肿各3例，血管瘤2例；恶性间质肿瘤5例：食管间质瘤（esophageal gastrointestinal stromal tumor E-GIST）4例，原始神经外胚层肿瘤（primitive neurotodermal tumour，PNET）1例；恶性上皮来源肿瘤为2例食管癌。本组4例食管旁淋巴结结核因忽视CT检查，术前未确诊；食管癌因忽视症状进展快，胃镜下管腔狭窄的特征，在分期不清的情况下行食管切除吻合术；高度恶性GIST忽视黏膜溃疡等特征，仅行摘除术，术后复发。结论 食管平滑肌瘤术前误诊比较多见；食管旁淋巴结结核与食管GIST为最常见误诊病种；术前CT是鉴别食管平滑肌瘤与食管旁淋巴结结核的关键检查。

Objective To analyze the causes of misdiagnosis of esophageal leiomyoma. Methods The clinical data of 20 patients who were preoperatively misdiagnosed as esophageal leiomyoma at our hospital in 16 years were retrospectively ana- lyzed. There were 11 males （ 55 % ） and 9 females （45 % ） with a mean age of（45.9 ± 16.4 ） years （ range, 13 - 71 years ）. The initial presentations were obstruetive symptoms in 12 patients（60% ）. CT imaging were performed in 9 patients（45 % ） , of which 4 eases were enhanced CT（20% ）. Results The misdiagnosed patients included 5 eases of extraesophageal lesions （4 eases of paraesophageal lymph node tuberculosis and 1 ease of lymph node hyperplasia） , 8 eases of begin interstitial diseases （3 eases of neurinoma, 3 eases of inclusion cyst, 2 eases of angioma） , 5 eases of malignant interstitial diseases（4 eases of GIST, 1 ease of PNET）, and 2 eases of esophageal cancer. The 4 eases of esophageal tuberculosis were misdiagnosed due to the ab- sence of CT examination. The patients with esophageal cancer were treated with esophageal resection and reconstruction without clear staging of the tumor. This might he associated with the neglection of the rapid symptom development and the characteristic lumen stenosis under the gastroscope. The characteristic mueosal ulcer in patients with highly malignant GIST was overlooked. The disease relapsed postoperatively because only tumor enucleation was performed. Conclusion Preoperative diagnosis of e- sophageal leiomyoma is not uncommon. This disease is most often misdiagnosed as paraesophageal lymph node tuberculosis or e- sophageal GIST. CT examination is useful in distinguishing esophageal leiomyoma and paraesophageal lymph node tuberculosis. The roles of reoperation and adjuvant therapy in the surgical treatment of esophageal leiomyoma need further investigation.