ABSTRACT
Objective To evaluate the valuse of endoscopic ultrasonography ( EUS ) for upper gastrointestinal submucosal lesions and the role of Photoshop in differentiating leiomyoma and stromal tumors. Methods Data of 656 patients with upper gastrointestinal submucosal lesions evaluated by EUS and receiving endoscopic submucosal dissection ( ESD ) from April 2010 to March 2015 were collected and retrospectively analyzed. The goldern standard for lesions size and origin was the intraoperative diagnosis of ESD, and that of the type of lesions ( leiomyoma, stromal tumor, ectopic pancreas, lipoma, etc.) was pathological and immunohistochemical finding. The consistency of diagnosis of the EUS was evaluated. In addition, Photoshop was used to differentiate diagnosis of leiomyoma and stromal tumors which were confirmed by pathology and immunohistochemistry. Results The consistency in diagnosing the size and lesion origins was 92?56%(560/605) and 88?43%(535/605)between EUS and ESD intraoperative result. The consistency in pathological types of EUS was 79?34%(480/605). Photoshop was used to analyze the EUS images of 177 stromal tumor and 241 leiomyoma. The gray value of stromal tumor was significantly higher than that of leiomyoma(59?97 VS 39?39, t=43?27, P<0?05).The echo of stromal tumor was higher. The standard deviation of gray value of leiomyoma were significantly lower than that of the stromal tumor ( 4?81 VS 5?42, t = 2?83, P < 0?05 ) , indicating the echo uniformity of leiomyoma was better. Conclusion EUS shows high accuracy rate for upper gastrointestinal submucosal lesions, providing more accurate basis for endoscopic therapy. EUS combined with Photoshop is helpful for differentiating stromal tumor from leiomyoma.
ABSTRACT
Basaloid squamous carcinoma is a rare, pooly differentiated variant of squamous cell carcinoma. It occurs in various sites, including the upper digestive tract, the esophagus, lung, anus, cervix and thymus. It has been postulated that basaloid carcinoma may arise from outside of the anal canal, such as at where the cloacogenic embryologic cells rest, the squamous metaplastic epithelium, or the totipotential basal cells. This tumor is a distinct entity that should be carefully distinguished from basal cell carcinomas of the anal canal, which is a condition that has a very good prognosis, and anal or perianal squamous cell carcinomas, which have a different path of spread and they vary considerably in their behavior. We report here on a patient with basaloid squamous carcinoma in the distal rectum that manifested as multiple submucosal lesions, and the patient presented with abdominal pain and blood tinged stool.