胃底腺型胃癌的临床病理特征分析  

Gastric adenocarcinoma of the fundic gland type:endoscopic and clinicopathologic alanalysis

作　　者：刘明[1] 谢佳宜 陈振煜[1] 项立[3] 陈春林[3] 覃泳缤 黄世杰 钟琼 文静 张强[1] 青海涛[1] 狄连君 朱加兴 孙琦[8] 陈光勇[9] 王亚东[1] 白杨[1] 刘思德[1] 罗晓蓓[1] 韩泽龙[1] LIU Ming;XIE Jia-yi;CHEN Zhen-yu;XIANG Li;CHEN Chun-lin;QIN Yong-bing;HUANG Shi-jie;ZHONG Qiong;WEN Jing;ZHANG Qiang;QING Hai-tao;DI Lian-jun;ZHU Jia-xing;SUN Qi;CHEN Guang-yong;WANG Ya-dong;BAI Yang;LIU Si-de;LUO Xiao-bei;HAN Zedong(Department of Gastroenterology,Nat fang Hospital,Southern Medical University,Guangdiou 510515,China;The First Clinical Medical College of Southern Medical University,Guangzhou 510515,China;Department of Gastroenterology,Longgang District People's Hospital of Shenzhen,Shenzhen 518172,China;Department of Gastroenterology,Yulin Red Cross Hosftiud in Guangxi,Guangxi 537000,China;Department of Gastroenterology,Longnan Hospital of Traditional Chinese Medicine,Jiangxi 341700,China;Department of Gastroenterology,Affiliated Hospital of Zunyi Medical University,Zunyi 563003,China;Institute of Digestive Disease,Affiliated Hospital of Zunyi Medical University,Zunyi 563003,China;Department of Pathology,Affiliated Drum Tower Hosftital of Nanjing University Medical College,Nanjing 210008,China;Dpartmenl of Pathology,Beijing Friendship Hosjtitrd,Capital Medical University,Beijing 100050,China)

机构地区：[1]南方医科大学南方医院消化内科,510515 [2]南方医科大学第一临床医学院,510515 [3]深圳市龙岗区人民医院消化内科,518172 [4]广西玉林市红十字会医院消化内科,537000 [5]江西赣州龙南县中医院消化内科,341700 [6]贵州遵义医科大学附属医院消化内科,563003 [7]贵州遵义医科大学附属医院贵州省消化疾病研究所,563003 [8]南京大学医学院附属鼓楼医院病理科,210008 [9]北京市首都医科大学附属友谊医院病理科,9100050

出　　处：《现代消化及介入诊疗》2020年第7期851-855,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：广东省科技计划项目(2017B020209003;2019A141405016)。

摘　　要：目的探讨胃底腺型腺癌(gastric adenocarcinoma of fundic gland type,GA-FG)的临床病理学特征,以提高对该病的认识。方法收集2017年11月至2019年11月南方医科大学南方医院、玉林市红十字医院、龙南县中医院、深圳龙岗区人民医院诊断的8例胃底腺型胃癌患者资料,分析其内镜特征、病理形态特征、免疫组化结果、治疗及预后情况。结果全组男3例,女5例,年龄46~60(中位数56.5,平均数55)岁;多因体检发现胃部肿物入院,均无肿瘤家族史;7例(87.50%)无幽门螺杆菌感染。内镜特征:肿瘤主要位于胃上部(7例,87.50%),均未发现溃疡,背景黏膜均无萎缩表现;病变以隆起性多见(6例,75.00%),多可观察到分支血管(7例,87.50%);NBI放大观察可见病变与周边背景黏膜之间多无明显边界(7例,87.50%),表面微血管多为规则(7例,87.50%),表面微结构排列规则或不规则。瘤体最大径3~15(平均数7.4)mm,累及黏膜层5例(62.50%),浸润黏膜下层2例(浸润深度分别为196μm和454μm),均未发现脉管侵袭。最终病理诊断:胃底腺型胃癌(混合型)3例,胃底腺型胃癌(主细胞为主型)2例,胃底腺型胃癌(黏液颈细胞型)2例,胃底腺型胃癌(壁细胞为主型)1例。6例患者行ESD治疗,1例行EMR治疗,1例为活检病例。7例患者随访时间内均未见复发或转移。结论GA-FG是胃癌的一种新组织学类型,其内镜特征与一般的早期胃癌不太相同。对GA-FG的内镜、病理学特征仍需进一步的研究,以对提高对该病的诊断及鉴别诊断能力。Objective To explore the clinicopathological characteristics of gastric adenocarcinoma of fundic gland type(GA-FG).Methods Clinical data of 8 patients with GA-FG diagnosed by Nanfang Hospital,Yulin Red Cross Hospital in Guangxi,Longnan Hospital of Traditional Chinese Medicine and Longgang District People’s Hospital of Shenzhen from November 2017 to November 2019 were collected.The endoscopic features,pathological characteristics,immunohistochemical results,treatment and prognosis of 8 patients were analyzed retrospectively.Results There were 3 males and 5 females with age of 46 to 60(median 56.5,mean 55)years.The main reason for hospitalization was discovering gastric mass and no case had family history of carcinoma.The infection negative rate of H.pylori was 87.5%(7 cases).The gastroscopic examination showed following features:the predilection site of GA-FG was located in the upper third of the stomach(7 cases,87.50%);no ulcer or mucosal atrophy was found;6 cases were recognized by an elevated shape(75.00%);7 cases were observed branched vessels on the tumor surface(87.5%).Narrow-band imaging(NBI)showed indistinct demarcation line(7 cases,87.50%),regular microvascular patterns(7 cases,85%)on the entire tumor surface and the regular or irregular microsurface patterns.The average tumor diameter was 7.4(3~15)mm.The tumor invaded mucosal layer(5 cases,62.50%)and submucosal layer(2 cases,the invasion depths were 196μm and 454μm).Venous invasion was not be observed in all cases.The results of the final pathological diagnosis were as follows:3 cases were diagnosed as the combination type,2 cases were the chief cell-dominant type,2 cases were the mucous neck cell-dominant type,1 case was the parietal cell-dominant type.6 cases were treated by ESD,1 cases by EMR and 1 case was biopsy.No recurrence or metastasis was found in 7 patients during the follow-up period.Conclusion GA-FG is a newly described entity with a lack of awareness among general surgical pathologists.It is vital to understand its endoscopic and pathol

关 键 词：胃肿瘤 免疫组化 内镜 窄带成像 

分 类 号：R735.2[医药卫生—肿瘤] R573[医药卫生—临床医学]