上消化道黏膜下肿瘤1237例次的病理学特征和分布特点

Analysis of pathological features and distribution characteristics of 1237 upper gastrointestinal submucosal tumors

目的探讨上消化道黏膜下肿瘤(SMT)的病理学特征和分布特点。方法回顾性分析温州医科大学附属台州医院消化内科2013年1月至2017年12月经内镜治疗、病理和免疫组织化学检查确诊的1182例(1237例次)上消化道SMT住院患者的病历资料,分析病理类型、分布部位、内镜下表现、起源层次、肿瘤大小等。结果食管SMT共473例次,其中平滑肌瘤387例次(81.8%),均位于黏膜肌层或固有肌层,囊肿59例次(12.5%),均位于黏膜下层或黏膜肌层;食管上段138例次(29.2%),食管中段159例次(33.6%),食管下段176例次(37.2%),均以平滑肌瘤多见。胃SMT共723例次,其中胃肠间质瘤284例次(39.3%),平滑肌瘤273例次(37.8%),均位于固有肌层;贲门部69例次(9.5%),常见为平滑肌瘤55例次(79.7%),胃肠间质瘤9例次(13.0%);胃底部239例次(33.1%),常见为胃肠间质瘤152例次(63.6%),平滑肌瘤79例次(33.1%);胃体部280例次(38.7%),常见为平滑肌瘤138例次(49.3%),胃肠间质瘤111例次(39.6%);胃窦部127例次(17.6%),常见为异位胰腺71例次(55.9%),脂肪瘤26例次(20.5%),均位于黏膜下层,部分累及固有肌层;胃角6例次(0.8%);胃肠吻合口2例次(0.3%)。十二指肠SMT共41例次,其中十二指肠球部23例次(56.1%),常见为囊肿10例次(43.5%),脂肪瘤5例次(21.7%),异位胰腺5例次(21.7%);十二指肠降部18例次(43.9%),常见为脂肪瘤9例次,囊肿5例次,均位于黏膜下层。结论食管全段和贲门部SMT最常见为平滑肌瘤,胃底和胃体部SMT多为平滑肌瘤和胃肠间质瘤,胃窦部SMT多为异位胰腺和脂肪瘤,十二指肠球部和降部SMT多为囊肿和脂肪瘤。

Objective To explore the pathologic features and distribution characteristics of upper gastrointestinal submucosal tumors (SMT). Methods From January 2013 to December 2017, at Department of Gastroenterology of Taizhou Hospital Affiliated to Wenzhou Medical University, clinical data of 1 182 hospitalized patients with 1 237 upper gastrointestinal SMT who underwent endoscopic therapy and diagnosed by pathology and immunohistochemistry was retrospectively analyzed including the pathological types, tumor of locations, endoscopic findings, layer of origin and tumor size. Results There were 473 esophageal SMT, including 387(81.8%) leiomyomas, located in the mucosal muscularis or muscularis propria;and 59(12.5%) cysts located in the submucosa or mucosal muscularis. There were 138(29.2%) lesions, 159(33.6%) lesions and 176(37.2%) lesions in the upper, middle and lower esophagus respectively, and the most common type was leiomyoma. A total of 723 tumors were gastric SMT, among them 284(39.3%) lesions were gastrointestinal stromal tumors (GIST) and 273(37.8%) lesions were leiomyomas, and all located in the muscularis propria. A total of 69(9.5%) lesions located at cardia, the common types were leiomyoma (55 lesions, 79.7%) and GIST (nine lesions, 13.0%). A total of 239 (33.1%) lesions located at gastric fundus, the common types were GIST (152 lesions, 63.6%) and leiomyoma (79 lesions, 33.1%). A total of 280(38.7%) lesions located at gastric body, the common types were leiomyoma (138 lesions, 49.3%) and GIST (111 lesions, 39.6%). A total of 127(17.6%) lesions located at gastric antrum, the common types were heterotopic pancrease (71 lesions, 55.9%) and lipoma (26 lesions, 20.5%), and all were located in the submucosa, some involved the muscularis propria. There were six (0.8%) lesions at gastric angle, and two (0.3%) at gastrointestinal anastomosis. Forty-one lesions were duodenal SMT, among them 23(56.1%) located at duodenal bulb, the common types were cyst (10 lesions, 43.5%), lipoma (five lesions, 21.7%) and heterotopic pancrease (five lesions, 21.7%). A total of 18(43.9%) lesions located at descending duodenum, the common types were lipoma (nine lesions, 50.0%) and cyst (five lesions, 27.8%), and all lesions located in the submucosa. Conclusions The most common type of SMT in the esophagus and cardia is leiomyoma, however the SMT in gastric fundus and body are mostly leiomyomas and GIST, while in gastric antrum, most SMT are heterotopic pancreases and lipomas. In duodenal bulb and descending duodenum, the common types of SMT are cyst and lipoma.