Histopathologic features in esophagomyotomy specimens from patients with achalasia

被引:216
作者
Goldblum, JR
Rice, TW
Richter, JE
机构
[1] CLEVELAND CLIN FDN,DEPT THORAC & CARDIOVASC SURG,CLEVELAND,OH 44195
[2] CLEVELAND CLIN FDN,DEPT GASTROENTEROL,CLEVELAND,OH 44195
关键词
D O I
10.1053/gast.1996.v111.pm8780569
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: A previous study evaluating the morphological features of esophagi resected for endstage achalasia showed marked depletion of myenteric ganglion cells, widespread destruction of nerves, and variable chronic inflammation. The aim of this study was to evaluate the histological features in esophagomyotomy specimens from 11 patients with early achalasia, defined as minimal to moderate esophageal dilation without sigmoid deformity. Methods:The histological features of esophagomyotomy specimens from 11 patients with achalasia were analyzed and compared with the findings of control specimens obtained from 8 patients who underwent esophagectomy for intramucosal adenocarcinoma. Results: Control specimens had normal numbers of ganglion cells (0.70-0.91 ganglion cells per high-power field) and minimal inflammation. Three patients with vigorous achalasia had normal ganglion cell numbers (0.79-0.91 ganglion cells per high-power field) and at least mild myenteric inflammation without neural fibrosis. The remaining 8 patients had few or no ganglion cells (0-0.30 ganglion cells per high-power field) and at least mild myenteric inflammation and neural fibrosis. Ganglionitis was found in 2 cases. Ganglion cell number was inversely correlated with degree of myenteric: neural fibrosis (P < 0.001). Conclusions: Vigorous achalasia has pathological features that are distinct from classic achalasia, The earliest pathological changes consist of myenteric inflammation with injury to and subsequent loss of ganglion cells and injury to and fibrosis of myenteric nerves.
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页码:648 / 654
页数:7
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