4例胃底腺来源肿瘤的临床病理特征  

Clinical pathological characteristics of 4 cases of gastric gland-derived tumors

作　　者：王翠翠 顾嘉 姜贝贝 曹瑞雪 刘晓红 Wang Cuicui;Gu Jia;Jiang Beibei;Cao Ruixue;Liu Xiaohong(Department of Pathology,the 960 Hospital of Chinese People′s Liberation Army,Jinan 250000,China)

机构地区：[1]解放军联勤保障部队第960医院病理科,济南250000

出　　处：《中华肿瘤杂志》2021年第7期781-786,共6页Chinese Journal of Oncology

摘　　要：目的探讨胃底腺来源肿瘤胃泌酸腺腺瘤(OGA)和胃底腺型腺癌(GA-FG)的临床病理特征。方法对解放军第960医院2019年2月至2019年9月确诊的2例OGA和2例GA-FG进行回顾性分析,采用光镜切片和免疫组织化学染色,结合内镜分析其组织学的主要特征。结果OGA和GA-FG均分化较好,位于黏膜固有层的深部。2例OGA局限于黏膜内,其中1例OGA腺体呈不规则管状,结构异型性较小,属于低度异型,1例OGA腺体呈不规则的管状、分枝状或吻合状,属于高度异型;2例GA-FG伴有黏膜下浸润,腺体呈不规则的管状、分枝状或吻合状,可形成所谓的"无尽腺"结构。肿瘤表面腺体未见明显异型,周围黏膜无幽门螺杆菌感染、慢性炎症、肠化或萎缩等。2例OGA和2例GA-FG免疫组化结果相似,胃蛋白酶原1呈弥漫性阳性表达,提示肿瘤细胞主细胞分化;H+/K+ATPase和PDGFRA-α呈阳性表达,提示肿瘤细胞壁细胞分化。Syn均呈阳性表达而CD10、MUC2和CD-X2均阴性,未见p53过表达和β-catenin核阳性,热点区Ki-67增殖指数约为1%~5%。结论GA-FG为一种分化良好的、低度恶性的新的胃癌亚型。免疫组化及窄带成像结合放大内镜有助于鉴别诊断,Syn的阳性意义及能否成为诊断指标有待进一步研究。OGA由低度异型至高度异型至黏膜下浸润可能是GA-FG的发生过程,但发生机制尚不明确,多认为与Wnt/β-catenin和Shh信号通路有关,但有别于其他类型胃癌的发病机制。内镜下黏膜切除对病变的完整切除是首选治疗,通常是治愈性的。Objective To investigate the pathological features of gastric tumor originated from the fundic gland,including oxyntic gland adenoma(OGA)and gastric adenocarcinoma of the fundic gland(GA-FG).Methods A retrospective analysis of 2 cases of OGA and 2 cases of GA-FG admitted to our hospital from February 2019 to September 2019 was performed.The histological features were analyzed by immunohistochemical staining combined with endoscopic observation.Results The four cases arose from the deep layer of the lamina propria mucosae and well differentiated.Two cases of OGA confined to the mucosa,including 1 case of irregular tubules showing low-degree dysplasia and another case of irregular branching and anastomosing tubules showing high-degree dysplasia.Two cases of GA-FG combined with submucosal invasion,showed irregular branching and anastomosing tubules and formed a so-called"endless glands"pattern.Atypia,helicobacter pylori(HP)infection,chronic gastritis,intestinal metaplasia,or gastric atrophy were not observed in the superficial epithelium covering the tumor extent.Two cases of OGA and 2 cases of GA-FG showed the same result of immunohistochemical staining:pepsinogen-1 was diffusely positive in the tumor tissues and indicated chief cell differentiation,while positive ATPase and PDGFRA-αindicated parietal cells differentiation.The expression of Syn were positive in all cases,while CD10,MUC2 and CD-X2 were negative.The upregulation of p53 protein or nuclear positivity ofβ-catenin was not observed.The Ki-67 labeling index in the hot area was approximately 1-5%.Conclusions GA-FG is a well-differentiated,low-grade malignant novel subtype of gastric cancer.The immunohistochemical markers and narrowband imaging combined with magnifying endoscopy(NBI-ME)enhance the diagnostic sensitivity.Whether Syn positive expression can be one of the diagnostic item needs to be further investigate.The process of tumorigenesis of GA-FG might be the transition from low-grade dysplasia to high-grade dysplasia of OGA and further to submucosa

关 键 词：胃肿瘤 胃底腺型腺癌 胃泌酸腺腺瘤 MUC SYN 胃蛋白酶原1 

分 类 号：R735.2[医药卫生—肿瘤]