摘要
食管黏膜下腺导管腺瘤(esophageal submucosal gland duct adenoma,ESGDA)是一种罕见的良性肿瘤,起源于食管腺,多见于老年人。重庆大学附属涪陵医院消化内科于2023年6月收治1例68岁的女性ESGDA患者,该患者因“反复腹痛8年余,吞咽困难2年余”就诊,胃镜检查见食管距门齿约18 cm处有一表面光滑的隆起性病变;超声胃镜提示食管隆起位于黏膜肌层,呈低回声改变;组织学上肿瘤呈多个扩张的腺性囊腔,间质见大量淋巴细胞聚集及淋巴滤泡形成,囊腔内衬两层细胞,内侧为腺上皮细胞,外侧为肌上皮细胞,细胞温和,无明显异型。免疫组织化学染色示:腺上皮表达细胞角蛋白(cytokeratin,CK)19、CK5/6、CK7,肌上皮细胞表达CK5/6、P63、S-100,细胞增殖指数Ki-67约3%(+)。阿利新蓝-过碘酸希夫染色(Alcian blue periodic acid Schiff stain,AB-PAS):腺泡(+),瘤性导管(-)。病理诊断为ESGDA。患者行内镜下黏膜剥离术(endoscopic submucosal dissection,ESD),术后给予“雷贝拉唑钠肠溶片+康复新液”治疗,随访至2024年3月,无复发。ESGDA临床和内镜表现与平滑肌瘤、食管囊肿等类似,临床医生需提升对ESGDA的诊断能力,以减少误诊、漏诊。
Esophageal submucosal gland duct adenoma(ESGDA)is a rare benign tumor originating from the esophageal glands,commonly found in elderly individuals.In June 2023,the Department of Gastroenterology of Chongqing University Fuling Hospital,admitted a 68-year-old female patient diagnosed with ESGDA.The patient had a history of recurrent abdominal pain for over eight years and dysphagia for more than two years.Gastroscopy revealed a smooth,raised lesion located approximately 18 cm from the incisors in the esophagus.Endoscopic ultrasound showed the lesion was situated in the muscularis mucosa with a hypoechoic appearance.Histologically,the tumor exhibited multiple dilated glandular cysts with abundant lymphocytic infiltration and lymphoid follicle formation in the stroma.The cysts were lined by two layers of cells:the inner layer consisted of glandular epithelial cells,and the outer layer consisted of myoepithelial cells,with no significant cellular atypia.Immunohistochemical staining showed that the glandular epithelium expressed cytokeratin(CK)19,CK5/6,CK7,while the myoepithelial cells expressed CK5/6,P63,and S-100.The cell proliferation index,Ki-67,was about 3%positive.Alcian blue-periodic acid Schiff stain(AB-PAS)indicated positive staining for acinus but negative for neoplastic ducts.The pathological diagnosis was ESGDA.The patient underwent endoscopic submucosal dissection(ESD)and received postoperative treatment with rabeprazole sodium enteric-coated tablets and rehabilitation solution.Follow-up until March 2024 showed no recurrence.The clinical and endoscopic manifestations of ESGDA are similar to those of leiomyomas and esophageal cysts.Clinicians need to improve diagnostic capabilities for ESGDA to reduce misdiagnosis and missed diagnoses.
作者
李月
吴成芳
任俊伟
张冲
卫惠杰
LI Yue;WU Chengfang;REN Junwei;ZAHNG Chong;WEI Huijie(Department of Pathology,Chongqing University Fuling Hospital,Chongqing 408000;Department of Neurology,Chongqing University Fuling Hospital,Chongqing 408000,China)
出处
《临床与病理杂志》
CAS
2024年第7期1047-1052,共6页
Journal of Clinical and Pathological Research
关键词
黏膜下腺导管腺瘤
食管
诊断
病理特征
submucosal gland duct adenoma
esophagus
diagnosis
pathological features
