Weng Yan, Ran Jingxue, Peng Yongmei, Xiang Yining, Xu Liangbi
Clinical College of Guiyang Medical University, Guiyang, China.
Department of Pathology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
J Gastrointest Oncol. 2022 Jun;13(3):1121-1131. doi: 10.21037/jgo-22-369.
To explore the white light endoscopy and endoscopic ultrasonography (EUS) features of rectal hyperplastic polyps (rHP) misdiagnosed as rectal neuroendocrine neoplasms (rNENs). In rNENs with a diameter of 5-10 mm, the endoscopic findings are not typical and some of them are similar to rHP, so it is not uncommon to misdiagnose rNENs as rHP. However, misdiagnosis of rHP as rNENs has not been reported in the literature, which can alert clinicians to the existence of this possibility and avoid over-treatment.
We collected 245 cases of rectal submucosal tumor (SMT) diagnosed by endoscopy in our hospital from January 2015 to December 2020 and 103 patients with suspected rNENs identified through endoscopy. A retrospective analysis was conducted of the shape, color, vascular dilatation, and boundary on the surface of the lesion under white light endoscope, and the source, boundary, and echo characteristics of EUS. We also analyzed the endoscopic features of rHP misdiagnosed as rNENs. Endoscopic diagnosis and pathological diagnosis were reviewed by a senior endoscopic expert and pathologist respectively. The counting data were tested and analyzed by χ test and Fisher exact probability method.
A total of 103 cases of rNENs were diagnosed by endoscope, among whom 75 cases were confirmed as rNENs (72.8%) and 8 cases as rHP (7.8%) by histopathology. There was no significant difference between rNENs and rHP in terms of gender, age, clinical manifestation, shape and color of lesions, dilatation of blood vessels on the surface, and location of lesions. Meanwhile, there were significant differences in whether the boundary of the lesion was clear under white light endoscopy, and the source, echo, and boundary of the lesion under EUS.
The morphology of some rHP is similar to rNENs under endoscopy. The boundary is clear under white light endoscopy and the source, echo, and boundary under EUS are helpful for the diagnosis of rNENs and rHP.
探讨误诊为直肠神经内分泌肿瘤（rNENs）的直肠增生性息肉（rHP）的白光内镜及内镜超声（EUS）特征。在直径为5 - 10 mm的rNENs中，内镜表现不典型，部分与rHP相似，因此将rNENs误诊为rHP并不少见。然而，rHP误诊为rNENs在文献中尚未见报道，这可提醒临床医生存在这种可能性并避免过度治疗。
收集我院2015年1月至2020年12月期间经内镜诊断的245例直肠黏膜下肿瘤（SMT）及103例经内镜检查怀疑为rNENs的患者。对白光内镜下病变表面的形态、颜色、血管扩张及边界，以及EUS的起源、边界及回声特征进行回顾性分析。同时分析误诊为rNENs的rHP的内镜特征。分别由资深内镜专家和病理学家对内镜诊断及病理诊断进行复核。计数资料采用χ检验和Fisher确切概率法进行检验分析。
共103例经内镜诊断为rNENs，其中75例经组织病理学确诊为rNENs（72.8%），8例为rHP（7.8%）。rNENs与rHP在性别、年龄、临床表现、病变形态和颜色、表面血管扩张及病变部位方面无显著差异。同时，白光内镜下病变边界是否清晰，以及EUS下病变的起源、回声及边界存在显著差异。
部分rHP在内镜下形态与rNENs相似。白光内镜下边界清晰，EUS下的起源、回声及边界有助于rNENs和rHP的诊断。
