Dieulafoy病伴癌变的临床病理分析

Clinicopathological Analysis of Dieulafoy Disease With Carcinogenesis

目的探讨Dieulafoy病及伴有癌变时的临床病理特征、弹力纤维染色、诊断及预后。方法回顾性分析19例Dieulafoy病以及其中的7例Dieulafoy病伴癌变的临床病理学资料,并复习相关文献。结果 19例Dieulafoy病患者的年龄15～70岁,平均年龄55.2岁,18例为男性,1例女性。7例伴癌变的患者年龄52～70岁,平均年龄61.4岁,全为男性。溃疡最大径0.6～3cm,7例伴癌变者溃疡最大径1.1～6 cm。镜下:黏膜下层可见增生扭曲,粗大畸形的厚壁血管,血管壁厚薄不均,其中7例伴发中-低分化胃管状腺癌,镜下于畸形脉管表面或周边见癌变的腺体呈浸润性生长。结论 Dieulafoy病是引起上消化道大出血的罕见原因之一,急诊内镜是主要的诊疗手段,但当伴发癌变时,Dieulafoy病的上消化道出血症状不明显,临床医生或因此采取保守治疗而将癌变漏诊。当临床诊断Dieulafoy病而行急诊内镜治疗时,必须警惕Dieulafoy病伴癌变的可能性,需仔细观察,在止血治疗后,后续胃镜检查必不可少,以免错过这种共存疾病。一旦诊断伴癌变,应以手术治疗为主。

Objective To investigate the clinicopathological features, elastic fiber staining, diagnosis and prognosis of Dieulafoyundefineds disease and canceration. Methods The clinicopathological data of 19 cases of Dieulafoyundefineds disease and 7 cases of Dieulafoyundefineds disease with canceration were retrospectively analyzed and the related literatures were reviewed. Results 19 patients with Dieulafoyundefineds disease were 15 ~ 70 years old (mean age 55.2 years), 18 were male and 1 female. Seven patients with canceration were 52 to 70 years old, mean age was 61.4 years old, all of them were male. The maximum diameter of ulcer was 0.6- 3 cm, and the maximum diameter of ulcer was 1.1-6 cm in 7 patients with carcinomatosis. Under the microscope, the thick wall vessels with hyperplasia and distortion, the thick wall vessels with coarse deformities and the uneven thickness of the vessel walls were seen in submucosa. In 7 cases with moderate to low differentiation gastric tubular adenocarcinoma, the canceration glands on or around the surface of the malformed vessels showed infiltrative growth under the microscope. Conclusion Dieulafoyundefineds disease is one of the rare causes of upper gastrointestinal hemorrhage. Emergency endoscopy is not only the main method to diagnose Dieulafoyundefineds disease, but also to replace surgery as the main method to treat the disease, and the prognosis is good, but when it is accompanied by canceration, the emergency endoscopy is the main method to treat the disease. The symptoms of upper gastrointestinal bleeding in Dieulafoyundefineds disease may not be obvious and the clinician may miss out on cancerization because of conservative treatment. It is suggested that the possibility of Dieulafoy with carcinogenesis should be alerted when the Dieulafoy disease is diagnosed by emergency endoscopy in order to avoid missing this coexisting disease.