胃底腺来源腺癌的临床病理学特征及基因分析  

Clinicopathological features and genetics analysis of gastric adenocarcinoma from the fundic gland

作　　者：张晓红 王玉娥 杨静 王烨 刘晓江 王志蕙 姚少波 ZHANG Xiaohong;WANG Yu’e;YANG Jing;WANG Ye;LIU Xiaojiang;WANG Zhihui;YAO Shaobo(Department of Pathology,Linyi Tumor Hospital,Shandong Province,Linyi 276000,China;Department of Endoscopy Center,Linyi Tumor Hospital,Shandong Province,Linyi 276000,China;Department of Pathology,Linyi Traditional Chinese Medicine Hospital,Shandong Province,Linyi 276000,China)

机构地区：[1]山东省临沂市肿瘤医院病理科,山东临沂276000 [2]山东省临沂市肿瘤医院内镜中心,山东临沂276000 [3]山东省临沂市中医医院病理科,山东临沂276000

出　　处：《中国医药导报》2023年第5期111-115,共5页China Medical Herald

基　　金：山东省医药卫生科技发展计划项目(202103030190)。

摘　　要：目的探讨胃底腺来源腺癌的临床病理学特征及基因特征。方法收集2017年1月至2022年3月山东省临沂市肿瘤医院7例及山东省临沂市中医院2例胃底腺来源腺癌患者,回顾性分析其临床病理学特点,并行免疫组织化学染色及二代测序(NGS)检测。结果8例病变表面被覆正常小凹上皮,其下见低度异型腺体增生,诊断为胃底腺型腺癌(GA-FG);1例黏膜结构层次紊乱,肿瘤性小凹上皮及低度异型腺体混杂增生,诊断为胃底腺黏膜型腺癌(GA-FGM)。其中7例GA-FG及1例GA-FGM周围黏膜未见萎缩、肠上皮化生及幽门螺杆菌感染。免疫组织化学染色结果显示,8例GA-FG均表达黏蛋白(MUC)6、胃蛋白酶原Ⅰ、H^(+)/K^(+)-腺苷三磷酸酶(ATPase),MUC5AC仅在表面正常小凹上皮表达;1例GA-FGM瘤细胞表达MUC6、MUC5AC、胃蛋白酶原Ⅰ、H^(+)/K^(+)-ATPase。NGS检测结果显示,2例GA-FG存在GNAS错义突变,1例GA-FGM存在BRAF、TP53错义突变。结论GA-FG是一种罕见的低度恶性肿瘤,虽常浸润黏膜下层,但大多数预后较好,而GA-FGM具有不同的临床病理学特点,预后稍差。Objective To investigate the clinicopathological features and genetic characteristics of gastric adenocarcinoma from the fundic gland.Methods From January 2017 to March 2022,seven cases in Linyi Tumor Hospital and two cases in Linyi Traditional Chinese Medicine Hospital of Shandong Province with adenocarcinoma from fundus gland were collected.The clinicopathological features were analyzed retrospectively,and immunohistochemical staining and next generation sequencing(NGS)were detected.Results Eight cases were diagnosed as gastric adenocarcinoma of fundus gland type(GA-FG),with the surface of the lesions covered by normal concave epithelium and low grade dysplasia below.One case was diagnosed as gastric adenocarcinoma of fundic gland mucosa type(GA-FGM)with mucosal structure disorder,neoplastic concave epithelium,and low-grade dysglandular mixed hyperplasia.No atrophy,intestinal metaplasia,and Helicobacter pylori infection were observed in the surrounding mucosa of seven GA-FG and one GA-FGM cases.Immunohistochemical staining showed that mucin(MUC)6,pepsinogenⅠ,and H^(+)/K^(+)-adenosine triphosphatase(ATPase)were expressed in all the eight GA-FG cases,while MUC5AC was only expressed in normal concave epithelium.The tumor cells of one GA-FGM case expressed MUC6,MUC5AC,pepsinogenⅠand H^(+)/K^(+)-ATPase.The results of NGS detection showed that two GA-FG cases had GNAS missense mutations,and one GA-FGM case had BRAF and TP53 missense mutations.Conclusion GA-FG is a rare low-grade malignant tumor,which often infiltrates submucosa,but has a good prognosis in most cases,while GA-FGM has different clinicopathological characteristics and a slightly worse prognosis.

关 键 词：胃底腺 胃底腺型腺癌 胃底腺黏膜型腺癌 GNAS突变 

分 类 号：R735.2[医药卫生—肿瘤]