食管皮脂腺异位内镜表现和临床病理分析（附国内19例报告）

Endoscopy and clinicopathological characteristics of esophageal ectopic sebaceous glands (19 cases)

摘要:

总结食管皮脂腺异位的内镜表现和病理特点，提高临床、内镜和病理医生对该病的认识和诊断能力。方法 收集吉林大学白求恩第一医院收治的5例以上消化道症状起病的食管皮脂腺异位患者的临床资料，并检索文献中的14例食管皮脂腺异位的患者资料，分析该病患者的内镜下表现和病理特点。结果 19例患者中2例无临床症状，其余以上腹部不适、上腹部饱胀、上腹痛、胸骨后哽咽感、进食异物感、反酸和烧心等就诊，其中胸骨后哽咽感、进食异物感与该病相关性强，该病无阳性体征。该病内镜下常见诊断为黄色（斑）瘤（26.32%）、脂肪瘤（15.79%）、食管结节性增生（5.26%）、霉菌性食管炎（5.26%）和食管白斑（5.26%）等，误诊率高，病变多位于食管中下段（84.21%）。所有患者均经病理证实为食管皮脂腺异位，病理表现为成熟或幼稚皮脂腺细胞。结论 食管皮脂腺异位为少见临床病变，临床无特异症状，误诊率高，应提高鉴别诊断能力，特别是与浅表型食管癌鉴别。该病确诊有赖于内镜及病理活检，预后较好。

Abstract:

To summarize the endoscopic characteristic and pathological features of esophageal sebaceous glands, to improve the recognition and diagnosibility of clinician, endoscopic physicians and pathologists for this disease. Methods 5 cases from the first Bethune hospital of Jilin University, starting with gastrointestinal symptoms and 14 cases in the related domestic literatures were studied. Its endoscopy and clinicopathological manifestations were analyzed. Results Among the 19 patients, no clinical symptoms in two cases, others as abdominal discomfort, upper abdominal fullness, epigastric pain, retrosternal choked feeling, eating foreign body sensation, acid reflux and heartburn and so on. Sensation of retrosternal choked and eating foreign body sensation had strong correlation with this disease. There were no positive signs in this disease. Endoscopic diagnosis of the disease were: xanthoma (26.32%), lipoma (15.79%), esophageal nodular hyperplasia (5.26%), fungal esophagitis (5.26%), esophageal leukoplakia (5.26%) and so on. The disease, which had high rate of misdiagnosis, mostly is located in the middle and lower of esophagus (84.21%). All the patients were pathologically confirmed as esophageal ectopic sebaceous gland, the pathology was mature or immature sebaceous cell. Conclusion With no clinical specific symptoms, esophageal ectopic sebaceous gland is rarely clinical lesions and highly misdiagnosed. The differential diagnosis ability should be improved, especially with the identification of superficial esophageal cancer. The diagnosis of the disease depends on endoscopy and biopsy. The disease has a favorable prognosis.