消化系统颗粒细胞瘤的研究进展.pdfVIP

·838· 中国肿瘤临床 2009年第36卷第14期 消化系统颗粒细胞瘤的研究进展 刘素丽 综述 邢国璋 审校 河北省人民医院内镜诊疗科 （石家庄市 050051） 摘要 消化系统颗粒细胞瘤在临床上非常少见，是一种来源于黏膜下层、具有雪旺细胞分化特征的神经源性 肿瘤，生长缓慢，一般为孤立性结节，形态不规则，显微镜下瘤细胞呈巢状及索状排列，免疫组化显示神经特异性标 记S-100蛋白表达阳性，恶性瘤细胞显著异型性。消化系统颗粒细胞瘤多无临床症状，常在内镜检查时发现，表现 为灰白色或淡黄色黏膜下半球形结节，表面光滑，内镜下深挖或大块活检可提高病理诊断的准确率，超声内镜检查 可显示肿瘤起源层次及扩散范围。通常认为有无转移、手术切除后是否复发是良恶性颗粒细胞瘤鉴别的主要标 准。对直径20mm的颗粒细胞瘤，首选内镜下局部微创切除治疗，对多发或来源于肌层的颗粒细胞瘤及恶性颗粒 细胞瘤主要治疗手段为手术切除，放、化疗目前研究很少。消化系统颗粒细胞瘤治疗后复发率较高，恶性颗粒细胞 瘤术后局部复发率达32%～59%，并可发生远处转移，广泛转移是致死的主要原因。 关键词 消化系统 颗粒细胞瘤 研究进展 doi:10.3969/j.issn.1000-8179.2009.14.017 RecentAdvancesinResearchonGranularCellTumorinDigestiveTract LIU Suli, XING Guozhang Corresponding author: LIU Suli, E-mail: suliliu2007@163.com Department of Endoscopy, People ’s Hospital of Hebei Province, Shijiazhuang 050051, China Abstract Granular cell tumor (GCT) in the digestive tract, rarely seen in clinical practice, is a neurogen- ic tumor of schwann cell origin and is mainly located in the submucosa. Often solitary, GCT grows slowly, with irregular shape. Microscopically, the tumor forms solid cluster of cells of round or polygonal shapes associat- ed with few spindle cells. Immunohistochemistry shows S-100 proteins are present nearly in all cells within the tumor mass. The malignant features are often demonstrated as nuclear atypia. Most cases of GCT in the digestive tract have no clinical symptoms and are incidentally diagnosed upon gastrointestinal endoscopy ex- amination for their nonspecific dyspeptic symptoms. The tumors are mostly confined to submucosa and ap- pear as a yellowish or greyish white hemispherical