3.4 良性肿瘤

良性非上皮肿瘤包括平滑肌瘤、脂肪瘤、颗粒细胞瘤、神经纤维瘤和纤维血管瘤。所有这些在内镜检查中通常表现为黏膜下肿瘤，即圆形、凸起的肿块，表面覆盖正常黏膜。

最常见的食管良性肿瘤是平滑肌瘤，它起源于黏膜固有层的平滑肌细胞，较少起源于黏膜肌层。用内镜下器械（如闭式活检钳）触诊这种实性间叶性肿瘤，会感觉黏膜下病变质地较韧。上面被覆的黏膜是正常连续的。钳取组织行病理检查通常由于取材过于浅表，无法确定诊断。

血管瘤，由许多毛细血管或海绵状血管组成，在黏膜或黏膜下层内衬有内皮细胞，通常表现为蓝色或玫红色的结节状肿块。与平滑肌瘤和其他间叶性肿瘤相比，这类肿瘤质地柔软。报道，这类病变的内镜活检一般没有明显出血。

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