幽门腺腺瘤16例临床病理学观察  

Pyloric gland adenoma:a clinicopathological analysis of 16 cases

作　　者：周宾 岳冰[1] 徐瑞[1] 陈光勇[1] ZHOU Bin;YUE Bing;XU Rui;CHEN Guangyong(Department of Pathology,Beijing Friendship Hospital Affiliated with Capital Medical University,Beijing 100050,China;Department of Pathology,Zhuhai People’s Hospital/Zhuhai Hospital Affiliated with Jinan University,Zhuhai 519000,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]珠海市人民医院(暨南大学附属珠海医院)病理科,珠海519000

出　　处：《临床与实验病理学杂志》2024年第2期184-189,共6页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨幽门腺腺瘤(pyloric gland adenoma,PGA)的临床病理学特征。方法收集16例PGA的临床资料,采用免疫组化EnVision法检测PepsinogenⅠ、p53、MUC6、MUC5AC、CgA、Syn、CD56、Ki67、CDX-2、MUC2、β-catenin、CD10的表达,并分析其与临床病理特征及预后的关系。结果16例PGA患者中男性7例,女性9例。平均年龄58岁(范围26~81岁)。肿瘤平均最大径1.3 cm(范围0.2~4 cm)。肿瘤位于胃6例(胃体3例和胃底3例),十二指肠3例,胆囊7例。低级别PGA 7例,镜下见幽门腺样腺管紧密排列,内衬单层立方至低柱状细胞,核圆形、卵圆形,位于基底侧,核仁不明显,胞质透明或嗜酸性,呈毛玻璃样外观,细胞缺乏黏液帽;高级别PGA 1例,镜下见腺体结构紊乱、细胞核拥挤、核极向消失;其余8例混合低级别和高级别成分。5例发现鳞状桑葚样化生。根据免疫表型特点,16例中混合型(MUC5AC+,MUC6+)8例,纯幽门型(MUC5AC-,MUC6+)8例,未发现小凹优势型(MUC5AC+,MUC6-)。结论PGA是消化系统少见肿瘤,具有特征性形态学特点和免疫表型,因其有向恶性转化的风险,需提高警惕,尽量做到早发现、早诊断和早治疗。Purpose To investigate the clinical feature and histopathology of pyloric gland adenoma.Methods Clinical data of 16 cases of pyloric adenomas were collected.The expression of Pepsinogen I,p53,MUC6,MUC5AC,CgA,Syn,CD56,Ki67,CDX-2,MUC2,β-catenin,and CD10 was detected by immunohistochemistry EnVision method.The relationship with clinicopathological features and prognosis was analyzed.Results There were 7 males and 9 females,aged from 26 to 81 years with an average of 58 years.Tumor diameters ranged from 0.2 to 4 centimeter with a mean of 1.3 centimeter.The anatomical sites of the 16 PGA were stomach(6 cases),including 3 cases in body,3 cases in fundus and duodenum(3 cases).7 cases of low-grade PGAs were composed of closely packed pyloric-type glands,lined by cuboidal/low columnar epithelia.The nuclei(round to ovoid)were basally located,with inconspicuous nucleoli.Neoplastic cells characterized by a defined ground-glass appearance,with clear or eosinophilic cytoplasm.The cell was lack of a well-defined apical mucin cap.1 case of high-grade PGAs consistently exhibited architecture,crowded nuclei,and loss of nuclear polarity.The remaining 8 cases had both low-and high-grade components.Squamous morula was found in 5 cases.According to immunohistochemical characteristics,8 of 16 cases were mixed pattern(MUC5AC+,MUC6+).Others were pure pyloric type(MUC5AC-,MUC6+).No foveolar-dominant type(MUC5AC+,MUC6-)was found.Conclusion PGA is a rare tumor of the digestive system,with characteristic morphological characteristics and immunophenotype.Clinicians and pathologists need to strengthen their understanding and better manage patients because of the risk of malignant transformation.Early detection,early diagnosis and early treatment are needed.

关 键 词：幽门腺腺瘤 胃 十二指肠 胆囊 免疫组织化学 

分 类 号：R735[医药卫生—肿瘤]