如果是你,先看看这两个食管有没有问题?有问题的地方在哪里?
可能有点难度.....
Routineobservation:Amildlyreddishareaofabout8mmwasseen(arrows).Giventheabsenceofevidentgranularchangesattheredness,aninvasiondepthT1a-EPcancerwassuspected
白光下可见一约8mm轻度发红的病变,鉴于未见颗粒感改变,故考虑上皮内肿瘤可能性大。
Iodinestaining:Anareaunstainedwithiodinewasobservedatthesiteoftherednessseenbyroutineobservation
碘染后病对应区域呈负染区。
NBI:Thelesionwasvisualizedasabrownisharea(arrows)atthesiteoftherednessdetectedbyroutineobservation
NBI下观察病变对应区域呈茶褐色。
MagnifyingNBI:TypeVIvascularpatternwasrevealed
放大观察可见血管大部呈井上分型的V1型(个人认为也可见V2型)
Pathologicalfindings:Squamouscellcarcinoma,0-IIc,T1a-LPM,ly0,v0,HM0,VM0
病理提示为固有层鳞癌,切缘阴性,淋巴血管阴性。
DiagnosticPoints:
Iodine-unstainedareaswerescattered,butapositivepinkcolorsignwasrecognizedonlyatthissite,whichwouldhelpleadtothediagnosis.
诊断观察要点:在碘染多发分散的情况下,请注意粉红征的变化。
Routineobservation:Thelesion(arrows)wasdifficulttodetectbyroutineobservation
白光观察很难发现的一病变。(0-IIb,5-mm)
Iodinestaining:Thelesionwasseenasanareaunstainedwithiodineandwithapositivepinkcolorsign
碘染后呈负染区,粉红征阳性。
NBI:Thelesionwasvisualizedasabrownisharea(arrows)
MagnifyingNBI:TypeV1vascularpatternwasrevealed
NBI下呈茶褐色改变,放大观察IPCL大部分呈井上分型V1型改变,少量V2。
Pathologicalfindings:Squamouscellcarcinoma,0-IIc,T1a-LPM,ly0,v0,HM0,VM0
病理提示为固有层鳞癌,切缘阴性,淋巴血管阴性。
DiagnosticPoints:
Theiodine-unstainedareawithapositivepinkcolorsignandatypeVvascular
patternaresuggestiveofmalignancy.
诊断观察要点:碘染呈负染,粉红征阳性,V型血管均提示肿瘤性病变。
Routineobservation:Therewasareddishdepressionprotrudingfromthesquamous-columnarjunction(SCJ)tothesquamouscellepitheliumintheshapeofatongue.Althoughloweresophagealpalisadevesselswereunclear,theSCJappearedirregular;andthepresenceofshort-segmentBarrett’sesophagus(SSBE)wassuspected
位于SCJ的浅凹陷发红的舌形病变拟为SSBE,表面结构不规则,表面血管不清。
Indigocarminestaining:Depressionofthelesionbecameclearer.Therewasnosurfaceirregularityatthedepression
靛胭脂染色后病变清晰,表面结构基本规则。
MagnifyingNBI:Reticularvascularpatternwasobservedatthedepression,stronglysuggestingmalignancy
MagnifyingNBI:Achangeinmucosalstructureatthemarginofthedepressionwasrevealed,whichbetterdemarcatedtheboundary
网格状血管形态高度提示肿瘤性病变,边界线清晰存在。
Pathohistologicalfindings:Adenocarcinoma(tub1),M,ly0,v0,HM0,VM0
病理提示粘膜内高分化管状腺癌,切缘阴性,血管淋巴阴性。
DiagnosticPoint:
ItisnecessarytoobservecarefullythereddishmucosaattheSCJ.Inparticular,whenSSBEispresent,detectingachangeinmucosalstructureandabnormalbloodvesselsbymagnifyingNBIwouldhelpwiththediagnosis.
观察诊断要点:仔细观察SCJ附近的发红区域,当发现SSBE时,进一步放大观察表面结构及血管形态至关重要。
以上病例来源于《GastrointestinalCancerAtlasforEndoscopicTherapy
》如有兴趣可购买原书阅读。
一听倾心......