胃肠道颗粒细胞瘤的研究进展

The advancement of gastrointestinal granular cell tumor

颗粒细胞瘤是一种罕见的软组织肿瘤,现普遍被认为来源于神经系统施万细胞,免疫组化典型表现为S-100阳性。虽然颗粒细胞瘤大多数为良性,但已有恶性病例的报道,故区分良恶性很重要,鉴别良恶性肿瘤的主要病理学标准是转移和坏死。胃肠道的发病率为5%~11%,最常见的部位是食管、大肠和胃。胃肠道颗粒细胞瘤通常无特异性症状,大多数患者是在常规体检或因其他胃肠道症状行消化内镜检查时发现。内镜下表现多变,大多为黄白色、无蒂、表面黏膜完整的孤立小隆起,超声内镜下观察到的通常是起源于黏膜或黏膜下层的低回声、均质病变。确诊主要依据病理及免疫组织化学,消化内镜和超声内镜可辅助诊断。目前在治疗方面尚无专家共识,治疗方式由肿瘤的部位、大小以及侵犯层次决定,首选内镜下或手术切除,并行术后随访,也可选择保守观察。现结合文献对胃肠道颗粒细胞瘤的各项特征进行复习讨论。

Granular cell tumor(GCT)is a rare soft tissue tumor generally thought to be of Schwann cell origin and it is typically S-100 positive.While GCT is mostly benign,malignant GCT had been reported,and it is important to distinguish them.The main pathological criterias for distinguishing benign and malignant tumors are metastasis and necrosis.GCT occurs in the gastrointestinal tract(5%-11%),where the most commonly affected organs are esophagus,colon,and stomach.GCT is lack of specific clinical manifestations and usually found incidentally during esophagogastroduodenoscopy,colonoscopy or during the evaluation of non-specific symptoms.Endoscopically,they are typically yellow or white,sessile lesions covered by intact mucosa.On endoscopic ultrasound,they usually are hypoechoic,homogenous,smooth-edged lesions.There is no consensus on how to treat GCT.Conservative approaches,endoscopic and surgical resection are mainly treatments.Endoscopic resection includes endoscopic mucosal resection,endoscopic submucosal dissection and submucosal tunnel endoscopic resection.We reviewed and discussed the characteristics of gastrointestinal GCT based on the literature in this paper.