复发性移行细胞胆囊癌转移至胃肠道的超声内镜影像表现

作     者：Yusuf T.E. Levy M.J. Wiersema M.J. 朱国栋 

作者机构：Developmental Endoscopy Unit Div. of Gastroenterol. and Hepatol. Mayo Clinic 200 First St. SW Rochester MN 55905United States Dr. 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2005年第1卷第7期

页      面：25-25页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：胆囊癌 移行细胞 超声内镜 影像学 黏膜标本 细针穿刺活检 患者例数 肠腔狭窄 胆囊床 黏膜红斑 

摘      要：Background: Recurrent transitional cell bladder cancer (TCBC) can metastasize to the GI tract albeit uncommonly. This is the first report of the EUS appearan ce of metastatic TCBC to the GI tract. In addition to describing the EUS feature s of recurrent metastatic TCBC, this study determined the number of patients ref erred for evaluation of a primary GI luminal cancer in which EUS instead establi shed the diagnosis of metastatic recurrent TCBC. Methods: Patients referred from July 2000 through April 2004 for EUS evaluation of a suspected primary GI lumin al cancer were retrospectively reviewed. For patients with an established diagno sis of recurrent metastatic TCBC, EUS images were retrospectively reviewed to id entify characteristic features. Results: Of 2216 patients undergoing EUS to eval uate a suspected primary GI luminal cancer, 3 men (0.14% : 95% confidence int erval [0.02% , 0.29% ]) (mean age 67 years, range 54- 74 years) were found in stead to have recurrent metastatic TCBC involving the duodenum (n = 1) or rectum (n = 2). The patients presented a mean of 32 months after diagnosis of the prim ary TCBC with change in bowel habit (n = 1) and symptoms of bowel obstruction (n = 2). In each patient, initial endoscopy revealed circumferential luminal steno sis and mucosal erythema, but mucosal biopsy specimens revealed normal tissue. E US demonstrated hypoechoic, symmetric, circumferential wall thickening, loss of deep wall layers, and pseudopodia- like extensions into the peri- intestinal t issues. In the two patients with rectal involvement, no evidence of direct infil tration from the bladder bed was seen. EUS- guided FNA was diagnostic of metast atic TCBC in all patients. Conclusions: Although most cases of hypoechoic bowel - wall thickening and stenosis are from primary GI neoplasia, recurrent TCBC sh ould be considered in patients with a history of this tumor. Correct diagnosis i s important, because this allows selection of appropriate therapeutic inter