A pseudosarcomatous lesion resembling a malignant tumor of the esophagocardiac junction, diagnosed by a total biopsy with endoscopic surgery
A pseudosarcomatous lesion resembling a malignant tumor of the esophagocardiac junction, diagnosed by a total biopsy with endoscopic surgery
复制标题
类似食管贲门交界处恶性肿瘤的假肉瘤病变，通过内窥镜手术进行全活检诊断
作者：
Ando K;Fujiya M;Ito T;Watari J;et al
假肉瘤病变是一种临床或组织学上类似于肉瘤的良性病变，常常导致不必要或过度的治疗，包括食管切除术[1-3]。本报告介绍了一例假肉瘤病变，通过内镜粘膜下剥离术 (ESD) 进行全活检正确诊断[4]。一名60岁男子接受食管胃镜检查，以筛查上消化道。在下食管中检测到具有厚白色涂层的 5 毫米隆起（●" 图 1 a）。窄带成像（NBI）[5] 通过白色涂层中的裂缝显示规则扩张的毛细血管的花瓣状簇（●" 图 1 b）。活检标本的组织学检查显示发育不良的梭形细胞，对波形蛋白以外的上皮或间质标记物没有免疫反应性（●" 图 2 a），因此表明梭形细胞该病变在临床上与典型的肉瘤不一致，因此对标本进行了组织学检查，结果显示病变较深区域有血管和梭形细胞增多的肉芽组织（图2b，c），因此最终诊断为反应性炎症肉芽肿。本病例提示，ESD全活检可在内镜下准确控制粘膜下剥脱深度[4]，有助于肉瘤样病变的诊断，从而避免食管切除等过度治疗。从已报道的18例食管假肉瘤病变中(●"表1)[1-3, 6-9]，伴有溃疡和反流性食管炎的息肉样病变是典型的内镜表现。本病例显示了假肉瘤病变的特征性NBI表现，这可能是区分假肉瘤组织与恶性病变的关键。
A pseudosarcomatous lesion is a benign lesion resembling sarcoma either clinically or histologically, which often leads to unnecessary or excessive treatments, including esophagectomy [1–3]. This report presents a case of a pseudosarcomatous lesion which was correctly diagnosed by a total biopsy with endoscopic submucosal dissection (ESD)[4]. A 60-year-old man was examined by esophagogastroscopy to screen the upper gastrointestinal tract. A 5-mm elevation with a thick white coating was detected in the lower esophagus (●" Fig. 1 a). Narrow band imaging (NBI)[5] revealed petal-like clusters of regularly dilated capillaries through a crack in the white coating (●" Fig. 1 b).Histological examination of biopsy specimens showed dysplastic spindle cells with no immunoreactivity for epithelial or mesenchymal markers other than vimentin (●" Fig. 2 a), thus suggesting spindle cell sarcoma. The lesion was not clinically consistent with a typical sarcoma, therefore ESD was performed to make a definitive diagnosis. Histological examination of the specimen showed granulation tissue with augmentations of vessels and spindleshaped cells. Atypical-grade tissue tended to become less atypical in the deeper areas of the lesion (●" Fig. 2 b, c), thus resulting in a final diagnosis of reactive inflammatory granuloma with no tumorous component. This case suggests that a total biopsy by ESD, which can accurately control the depth of submucosal exfoliation under endoscopic view [4], is helpful for the diagnosis of sarcoma-like lesions, thereby avoiding excessive treatments including esophagectomy. From the 18 reported cases of esophageal pseudosarcomatous lesions (●" Table 1)[1–3, 6–9], a polypoid lesion with ulcers and reflux esophagitis is a typical endoscopic finding. The present case shows the characteristic NBI findings for a pseudosarcomatous lesion, which may be key for discrimination of pseudosarcomatous tissue from malignant lesions.