胃底腺型肿瘤的内镜与病理学分析  

Endoscopic and pathological analyses of fundic gland-type tumors

作　　者：陈建华[1] 施宏[1] 陈素玉[1] 黄瑞[1] 林丽琳[1] 张宇[1] Jianhua Chen;Hong Shi;Suyu Chen;Rui Huang;Lilin Lin;Yu Zhang(Department of Endoscopy Center,Clinical Oncology School of Fujian Medical University,Fujian Cancer Hospital,Fuzhou 350014,China)

机构地区：[1]福建医科大学肿瘤临床医学院,福建省肿瘤医院消化内镜中心,福州市350014

出　　处：《中国肿瘤临床》2024年第15期764-768,共5页Chinese Journal of Clinical Oncology

基　　金：福建省科技计划引导性项目(编号:2020Y0068)。

摘　　要：目的探讨胃底腺型肿瘤胃泌酸腺腺瘤(oxyutic gland adenoma,OGA)和胃底腺腺癌(gastric adenocarcinoma of fundic gland type,GA-FG)的临床病理特征。方法回顾性分析2020年8月至2023年2月福建省肿瘤医院收治的6例胃底腺型肿瘤患者,分析其临床资料、内镜学特征、病理特征、免疫组织化学结果,治疗及预后情况。结果6例患者中男性1例,女性5例,平均年龄57岁。主要发生部位为胃底、胃体,以浅表隆起型多见。病理形态特点为胃底腺型肿瘤大多位于胃黏膜深层,表现为腺体结构紊乱,主要由主细胞型细胞构成。其中OGA 3例,GA-FG 3例。免疫组织化学表达结果为胃蛋白酶原重组人抗体1(pepsinogen 1)阳性5例,MUC65例,突触素(synaptophysin,Syn)阳性6例,嗜铬蛋白(chromogranin,CgA)均为阴性,肿瘤增殖标记物(Ki-67)<10%。结论OGA与GA-FG发病率低,无明显的内镜学特异性,如内镜医师认识不足,易误诊漏诊;免疫组织化学有助于鉴别诊断,首选内镜下黏膜切除或者剥离术治疗。Objective To investigate the clinicopathological characteristics of oxyntic gland adenoma(OGA)and gastric adenocarcinoma of the fundic gland type(GA-FG).Methods Six cases of fundic gland-type tumors(three OGA and three GA-FG)diagnosed at the Fujian Cancer Hospital between August 2020 and February 2023 were retrospectively analyzed.The clinical data,endoscopic features,pathological characteristics,immunohistochemical results,treatment,and prognosis were analyzed.Results Six patients with an average age of 57 years,including one male and five females,were mainly affected in the gastric fundus and body,with the superficial elevated type being the most common.The pathological features of gastric gland-type tumors are mostly located in the deep layer of the gastric mucosa,showing a disordered glandular structure mainly composed of chief cell-type cells.There were three cases of OGA and three cases of GA-FG.Immunohistochemical results showed that pepsinogen 1 was positive in five cases,mucin 6(MUC6)in five cases,synaptophysin(Syn)in six cases,chromogranin(CgA)was negative in all cases,and Ki-67 was less than 10%.Conclusions The incidences of OGA and GA-FG are low,and there is no obvious endoscopic specificity.Endoscopy physicians have an insufficient understanding,which can easily lead to misdiagnoses and missed diagnoses.Immunohistochemistry is helpful for the differential diagnosis,and endoscopic mucosal resection or stripping is the preferred treatment option.

关 键 词：胃泌酸腺腺瘤 胃底腺腺癌 MUC6 内镜下黏膜下剥离术 

分 类 号：R735.2[医药卫生—肿瘤]