根除幽门螺杆菌后早期胃癌和背景黏膜病理学特征及其对活检病理诊断的提示意义  

Pathological features of early gastric cancer and its background mucosa after eradication of Helicobacter pylori and their implications for biopsy diagnosis

作　　者：孙晓宇 李静[2] 岳冰[1] 徐瑞[1] 贾梅 高杨 陈光勇[1] Sun Xiaoyu;Li Jing;Yue Bing;Xu Rui;Jia Mei;Gao Yang;Chen Guangyong(Department of Pathology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Pathology,Zibo Central Hospital,Zibo 255036,China)

机构地区：[1]首都医科大学附属北京友谊医院病理科,北京100050 [2]山东省淄博市中心医院病理科,淄博255036

出　　处：《中华病理学杂志》2023年第5期460-465,共6页Chinese Journal of Pathology

摘　　要：目的探讨根除幽门螺杆菌(Helicobacter pylori)后早期胃癌,特别是其背景黏膜的临床病理学改变,并探讨术前活检病理出现过低诊断的原因。方法收集首都医科大学附属北京友谊医院2016—2021年除菌后早期胃癌90例、未除菌早期胃癌的内镜黏膜下剥离术(ESD)标本120例及其对应的活检标本,分析患者的临床病理资料,对照观察组织形态学特征和免疫表型结果。结果(1)与无除菌史的早期胃癌相比较,除菌后早期胃癌的病理组织学类型均为分化型腺癌,肿瘤区域内癌性和非癌性上皮呈交错分布;(2)除菌后早期胃癌背景胃黏膜形态学具有特征性改变,包括胃黏膜肠化腺管开口增宽、腔缘呈锯齿状改变、肠化上皮胞质呈嗜酸性及微泡状;(3)除菌后胃癌上皮细胞存在低异型性,可能造成活检病理出现过低诊断或漏诊。结论根除幽门螺杆菌后早期胃癌及其背景黏膜具有独特的病理形态学特点,可以作为病理诊断的线索,提高活检病理准确性,减少过低诊断。Objective To investigate the clinicopathological changes of early gastric cancer,especially its background mucosa,after the eradication of Helicobacter pylori(H.pylori),and to investigate the causes of underdiagnosis in preoperative biopsy pathology.Methods Ninety cases of early gastric cancer after H.pylori eradication and 120 cases of endoscopic submucosal dissection(ESD)specimens without H.pylori eradication and their corresponding biopsy specimens were collected from Beijing Friendship Hospital Affiliated to Capital Medical University during 2016-2021.The clinicopathological data of the patients were analyzed,and the histopathological characteristics and immunophenotypic results compared.Results Compared with the early gastric cancer without H.pylori eradication history,the histopathological type of early gastric cancer after H.pylori eradication was differentiated adenocarcinoma,with staggered distribution of cancerous and non-cancerous epithelium in the tumor area.The morphologic characteristics of gastric mucosa in the background of early gastric cancer after H.pylori eradication,were distinctive,including widening of the opening of enterosylated glandular ducts,serrated change of luminal margin,eosinophilic and microvesicular cytoplasm of enterosylated epithelium.Low-grade atypia existed in gastric cancer epithelial cells after sterilization,which might lead to underdiagnosis or missed diagnosis in biopsy pathology.Conclusions Early gastric cancer and its background mucosa after H.pylori eradication have unique morphological characteristics,which can be used as a clue for pathological diagnosis,improve the accuracy of biopsy pathology and reduce the underdiagnosis.

关 键 词：胃肿瘤 螺杆菌 幽门 活组织检查 胃黏膜 

分 类 号：R735.2[医药卫生—肿瘤]