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目的探讨内镜超声引导下细针穿刺结合免疫组织化学检查在鉴别上消化道固有肌层肿瘤起源中的作用。方法选择经内镜发现并由内镜超声检查证实直径大于25 mm的上消化道固有肌层病变患者35例,内镜超声检查明确病变的大小、形态、位置,并观察有无周围脏器转移。在内镜超声导引下对病变行细针穿刺,对取材分别进行HE、CD117,CD34和肌动蛋白(SMA)染色。结果35例患者中,31例患者取得了足够的组织,经免疫组化染色,诊断为间质瘤21例,平滑肌瘤10 例。与术后诊断比较超声内镜结合免疫组织化学检查的敏感性为88.6%,特异性为100%。无一例患者出现不良反应。结论内镜超声引导下细针穿刺结合免疫组织化学检查是鉴别上消化道固有肌层肿瘤安全有效的方法。
Objective To investigate the role of endoscopic ultrasonography guided by fine needle aspiration and immunohistochemistry in differentiating the origin of tumors in the muscularis propria of the upper digestive tract. Methods 35 cases of upper myogenic muscular dysplasia with diameter more than 25 mm confirmed by endoscopy and endoscopic ultrasonography were identified. The size, shape and location of lesion were determined by endoscopic ultrasonography and the presence or absence of peripheral organs metastasis . Under the guidance of endoscopic ultrasonography, fine needle aspiration was performed on the lesion and HE, CD117, CD34 and actin (SMA) were stained separately. Results Of the 35 patients, 31 patients had adequate tissue. Immunohistochemical staining revealed 21 stromal tumors and 10 leiomyomas. Compared with postoperative diagnosis, endoscopic ultrasonography combined with immunohistochemistry showed a sensitivity of 88.6% and a specificity of 100%. No one patient showed adverse reactions. Conclusion Fine needle aspiration guided by endoscopic ultrasonography combined with immunohistochemical examination is a safe and effective method to identify the inherent myometrial tumors in the upper digestive tract.