背景:血管球瘤(GT)通常发生在皮肤中。然而,食道GT,极为罕见的情况,没有建立标准化的治疗指南。在这里,我们报道了1例食管GT在俯卧位经胸腔镜下应用食管内球囊压迫技术成功摘除的病例.
方法:一名45岁的男子接受了每年一次的内镜检查,发现食管下段有粘膜下肿瘤。内窥镜超声(EUS)显示起源于肌肉层的高回声肿块。对比增强计算机断层扫描在食管下段右侧发现了2cm的肿块病变,对比度增强较高。EUS引导的细针穿刺活检(EUS-FNA)的病理发现显示圆形至纺锤形的非典型细胞没有有丝分裂活性。免疫组织化学,肿瘤的α-平滑肌肌动蛋白呈阳性,但CD34阴性,desmin,角蛋白18,S-100蛋白,melanA,c-kit,STAT6他被诊断为食道GT,并计划采用胸腔镜手术切除肿瘤。在全身麻醉下,将Sengstaken-Blakemore(SB)管插入食道。将患者置于俯卧位,并实现了右胸腔镜入路。动员肿瘤周围的食道,并使SB管球囊膨胀以将肿瘤压向胸腔。肌肉层被分开,肿瘤被成功摘除,没有粘膜穿透。在术后第3天(POD)开始口服,患者在POD9时出院。术后1年随访均无手术并发症及肿瘤转移。
结论:由于食管GT的恶性标准尚未建立,完全切除的侵入性最小的手术应根据具体情况选择.使用食管内球囊压迫在俯卧位进行胸腔镜摘除术可用于治疗食管右侧的食管GT。
BACKGROUND: Glomus tumors (GT) generally occur in the skin. However, esophageal GT, an extremely rare condition, has no established standardized treatment guidelines. Herein, we report the
case of an esophageal GT successfully removed by thoracoscopic enucleation in the prone position using intra-esophageal balloon compression.
METHODS: A 45-year-old man underwent an annual endoscopic examination and was found to have a submucosal tumor in the lower
esophagus. Endoscopic ultrasound (EUS) revealed a hyperechoic mass originating from the muscular layer. Contrast-enhanced computed tomography identified a 2 cm mass lesion with high contrast enhancement in the right side of the lower esophagus. Pathologic findings of EUS-guided fine needle aspiration biopsy (EUS-FNA) revealed round to spindle shaped atypical cells without mitotic activity. Immunohistochemically, the tumor was positive for alpha-smooth muscle actin, but negative for CD34, desmin, keratin 18, S-100 protein, melan A, c-kit, and STAT6. He was diagnosed with an esophageal GT and a thoracoscopic approach to tumor resection was planned. Under general anesthesia, a Sengstaken-Blakemore (SB) tube was inserted into the
esophagus. The patient was placed in the prone position and a right thoracoscopic approach was achieved. The
esophagus around the tumor was mobilized and the SB tube balloon inflated to compress the tumor toward the thoracic cavity. The muscle layer was divided and the tumor was successfully enucleated without mucosal penetration. Oral intake was initiated on postoperative day (POD) 3 and the patient discharged on POD 9. No surgical complications or tumor metastasis were observed during the 1-year postoperative follow-up.
CONCLUSIONS: As malignancy criteria for esophageal GT are not yet established, the least invasive procedure for complete resection should be selected on a
case-by-
case basis. Thoracoscopic enucleation in the prone position using intra-esophageal balloon compression is useful to treat esophageal GT on the right side of the esophagus.