胃底腺型胃癌的内镜及病理特征分析  

Endoscopic and pathological features of gastric adenocarcinoma of the fundic gland type

作　　者：张兴华[1] 岳冰[2] 孙灿 张澍田[1] Zhang Xinghua;Yue Bing;Sun Can;Zhang Shutian(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing 100050,China;Department of Pathology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化科国家消化系统疾病临床医学研究中心消化分中心,北京100050 [2]首都医科大学附属北京友谊医院病理科,北京100050

出　　处：《中国医学前沿杂志（电子版）》2022年第9期34-40,共7页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：首都医科大学2021临床专科学院(系)开放课题。

摘　　要：目的总结新型胃癌———胃底腺型胃癌的临床、内镜及病理特征。方法回顾性分析2019年4月至2022年6月于国家消化系统疾病临床医学研究中心发现的20例胃底腺型胃癌病例,对临床表现、内镜特点、治疗及病理特征做了归纳和总结。结果胃底腺型胃癌缺乏特异性临床表现,白光内镜下表现为一种发生于胃底(65%)及胃体中上部(35%)正常胃底腺之上的黏膜下肿物样肿瘤,放大内镜下表现为渐进式由正常胃底腺黏膜逐渐过渡至腺管开口消失、“白区”异常鲜明以及血管异形型明显的病变区域,在超声内镜下表现为主体位于黏膜肌层的低回声占位,黏膜表层高回声似乎完整未中断,与黏膜下层分界欠清。病理方面,可见病变浅层有小凹上皮分布,深层见不规则的、相互融合的腺体,病变向深层延伸,突破黏膜肌层向下生长,部分侵犯黏膜下层。该型胃癌根据免疫组织化学标志物pepsinogen(主细胞)和H/K-ATPase(壁细胞)区分为主细胞型、壁细胞型和混合细胞型,临床上以主细胞型(76.5%)及混合细胞型(23.5%)多见。胃底腺型胃癌恶性度较低,内镜黏膜下剥离术可有效完整切除肿瘤。结论胃底腺型胃癌是一种容易漏诊的新型胃癌,需要内镜医生借助放大胃镜、超声胃镜来加强识别能力,基层医院可借助病理活检明确诊断,早期诊断并行内镜下治疗可取得良好预后。Objective To summarize the clinical,endoscopic and pathological features of gastric adenocarcinoma of the fundic gland type.Method 20 cases of gastric adenocarcinoma of the fundic gland type were retrospective enrolled in National Clinical Research Center for Digestive Diseases from 2019 April to 2022 June.The clinical features,endoscopic characteristics,treatment and pathological characteristics were summarized.Result Clinical features of gastric adenocarcinoma of the fundic gland type were not specific.Under while light endoscopy,submucosal tumor-like mass was presented above the normal fundic glands between the gastric fundus(65%)and the upper and middle part of gastric body(35%).Magnifying endoscopy showed normal mucosa of gastric glands gradually transformed to the disappear of gland duct opening,“White zone”abnormal bright and obvious vascular variation.Under ultrasound endoscopy,main part of the hypoechoic mass located in muscularis mucosa.Hyperechoic mucosal surface showed discontinuation and submucosa boundaries were unclear.The pathology indicated small concave epithelium distributed in superficial layer and irregular,fused glands in the deep layer.The lesion expanded toward deep layer,broke through the muscularis mucosa and partially invaded into submucosa.This type tumor could be divided into chief cell type(76.5%),parietal cell type and mixed type(23.5%)according to immunohistochemical markers pepsingen and H/K-ATPase.Gastric adenocarcinoma of the fundic gland type was a low degree of malignancy,and could be complete excision via endoscopic submucosal dissection surgery.Conclusion Gastric adenocarcinoma of the fundic gland type is a new type of gastric cancer with a high rate of missed diagnosis.Magnifying endoscope and ultrasound endoscope should be used to strengthen the ability to diagnosis.Biopsy pathology could be used in primary hospitals to make a clear diagnosis.Early diagnosis and endoscopic treatment can achieve good prognosis.

关 键 词：胃底腺型胃癌 放大胃镜 超声胃镜 病理特征 内镜下黏膜下剥离术 

分 类 号：R735.2[医药卫生—肿瘤]