“牵手型”早期胃癌临床、内镜和病理特征分析  

Clinical,Endoscopic and Pathological Characteristics of Crawling⁃type Early Gastric Adenocarcinoma

作　　者：高玮 赖跃兴 徐萍[1] 杨育生 孙玮玮 顾敏敏 曹静丽 冯雯[1] GAO Wei;LAI Yuexing;XU Ping;YANG Yusheng;SUN Weiwei;GU Minmin;CAO Jingli;FENG Wen(Department of Gastroenterology,Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine(Preparatory Stage),Shanghai,201600;Department of Pathology,Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine(Preparatory Stage),Shanghai,201600)

机构地区：[1]上海交通大学医学院附属松江医院(筹)消化内科,201600 [2]上海交通大学医学院附属松江医院(筹)病理科,201600

出　　处：《胃肠病学》2022年第2期75-80,共6页Chinese Journal of Gastroenterology

基　　金：上海市自然基金(22ZR1456500);上海市卫生健康委员会科研课题青年项目(20194Y0462)。

摘　　要：背景:“牵手型”胃癌是一种罕见的胃癌亚型,目前对该型胃癌的认知仍欠缺。目的:探讨“牵手型”早期胃癌的临床、内镜和病理特征。方法:连续收集2016年1月—2021年12月在上海交通大学医学院附属松江医院诊断为“牵手型”早期胃癌的病例,采集病史资料进行回顾性分析。同时对病理标本行免疫组化染色,并电话随访预后情况。结果:共14例符合筛选条件的“牵手型”早期胃癌患者纳入研究,其中男性9例,女性5例,平均年龄65.9岁。患者均无胃癌家族史,临床症状无特异性,幽门螺杆菌(Hp)感染均阳性。病灶主要位于胃中、下1/3,内镜下病灶背景黏膜均有萎缩,多为中重度萎缩。病灶大体形态浅表凹陷型(0‑Ⅱc)11例,浅表平坦型(0‑Ⅱb+Ⅱc)3例,色泽均发红,10例病灶边界不清晰。10例患者行内镜黏膜下剥离术,4例行外科手术治疗,均实现完全切除。病理结果黏膜下癌3例,黏膜内癌11例。免疫组化染色显示多数患者为混合型免疫表型,同时存在胃型标志物MUC5AC、MUC6和肠型标志物MUC2、CD10、CDX‑2阳性,Ki‑67指数多在30%~70%之间。术后平均随访38个月,所有患者均存活,2例在内镜随访中发现异时性早期胃癌。结论:对于Hp阳性、内镜下萎缩性胃炎背景的浅表凹陷型或浅表平坦型发红病灶,应考虑“牵手型”早期胃癌可能。对于此类患者,术前应充分评估病变范围和浸润深度,以指导手术方案的选择,术后应重视内镜随访。Background:Crawling‑type gastric adenocarcinoma is a rare subtype of gastric cancer,however,the understanding on this special entity of gastric cancer is still lacking.Aims:To investigate the clinical,endoscopic and pathological characteristics of crawling‑type early gastric adenocarcinoma.Methods:Patients diagnosed as crawling‑type early gastric adenocarcinoma in Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to December 2021 were recruited consecutively in a retrospective study.The clinical data were reviewed,the pathological specimens were collected for immunohistochemical staining,and a telephone follow‑up was conducted for prognosis analysis.Results:Fourteen patients with crawling‑type early gastric adenocarcinoma and fulfilling the inclusion criteria were enrolled in the study,of them,9 were male,5 were female,and the mean age was 65.9 years old.No family history of gastric cancer was reported.The clinical manifestations were not specific.All patients were positive for Helicobacter pylori(Hp)infection.Tumors were more likely to occur in the middle and lower thirds of the stomach,with marked atrophic background mucosa.Macroscopically,11 lesions were superficial‑depressed(0‑Ⅱc)and 3 were superficial‑flat type(0‑Ⅱb+Ⅱc).The color of the lesions was red.Lesions with indistinct border were observed endoscopically in 10 cases.Complete resection was achieved in all 14 patients after endoscopic submucosal dissection(n=10)or surgical treatment(n=4).Three submucosal and 11 intramucosal infiltration were observed pathologically.Immunohistochemical results of gastric(MUC5AC and MUC6)and intestinal(MUC2,CD10 and CDX‑2)markers showed that most of the patients were mixed immunophenotype;the Ki‑67 index ranged mostly between 30%and 70%.In a mean follow‑up time of 38 months,all 14 patients were survived.Two patients with heterochronous early gastric cancer were found by follow‑up endoscopy.Conclusions:When a superficial‑depressed or superf

关 键 词：牵手型胃癌 早期胃癌 体征和症状 内镜检查 病理学 

分 类 号：R735.2[医药卫生—肿瘤]