胃底腺型胃癌1例并文献复习  

Gastric adenocarcinoma of fundic gland type:A case report and literature review

作　　者：刘静[1] 刘连培 张蒙蒙 柴琳琳 李容 朱黎英 Liu Jing;Liu Lianpei;Zhang Mengmeng;Chai Linlin;Li Rong;Zhu Liying(Department of Gastroenterology,Qilu Hospital of Shandong University Dezhou Hospital,Dezhou 253032,China)

机构地区：[1]山东大学齐鲁医院德州医院消化内科,山东德州253032

出　　处：《临床荟萃》2024年第10期929-934,共6页Clinical Focus

摘　　要：目的探讨胃底腺型胃癌(gastric adenocarcinoma of fundic gland type,GA-FG)的临床特征、诊断及鉴别诊断。方法回顾性分析1例GA-FG患者的诊疗经过,并复习相关文献。结果患者为54岁女性,因胃镜检查时发现胃体上部SMT样褪色调病变。该病变表面黏膜光滑,可见扩张的树枝样血管改变;放大内镜技术联合窄带成像技术(ME+NBI)示:病变周边黏膜呈典型蜂窝状结果,病变呈茶褐色,表面微腺管可见融合,腺管开口大小不一,白区不规则,表面微血管不规则;超声胃镜示:可见胃体黏膜层病变,呈中等偏低回声,起源于黏膜层,与黏膜肌层分界不清,黏膜下层完整,大小约0.8 cm×0.5 cm。内镜下切除后病理:胃底腺型腺癌,镜下面积约:0.3 cm×0.3 cm,浸润至黏膜下层(漫润深度约220μm);脉管浸润(-),神经侵犯(-);水平切缘及垂直切缘未见癌细胞;周围黏膜组织慢性炎。免疫组化:MUC6(+);MUC5AC(-);P53无义突变(-);Desmin(示黏膜肌不完整);Syn个别细胞(+);CgA个别细胞(+);CD31及D2-40(脉管内未见癌栓);Ki-67阳性率约10%。结论GA-FG是一种新的组织学类型胃癌,具有独特的临床内镜及病理特征,预后良好,但需要长期随访。Objective To investigate the clinical characteristics,diagnosis and differential diagnosis of gastric adenocarcinoma of fundic gland type(GA-FG).Methods The diagnosis and treatment of a GA-FG patient were retrospectively analyzed,and the related literatures were reviewed.Results A 54-year-old woman had fading lesions of submucosal tumors(SMT)found in the upper part of the gastric body during gastroscopy.The mucosal surface of the lesion was smooth,and dilated dendritic vascular changes could be seen.Magnification endoscopy(ME)plus narrow-band imaging(NBI)showed typical honeycomb changes in the surrounding mucosa of the brown lesion,fused surface microglandular ducts,varied opening of the glandular ducts,irregular white area and surface microvessels.Ultrasonic gastroscopy showed that the mucosal lesions of the gastric body were visible,with moderate to low echo,originated from the mucosal layer;unclear boundary in the muscular layer of the mucosa;the submucosa was intact,with a size of about 0.8 cm×0.5 cm.Pathology after endoscopic resection showed:fundic adenocarcinoma with 0.3 cm×0.3 cm under the microscopy,infiltrated into the submucosa(diffuse depth of about 220μm);negative vascular and nerve invasion;no cancer was found in the horizontal and vertical margins.Chronic inflammation of the surrounding mucosa.Immunohistochemistry:positive MUC6;negative mUC5AC;negative p53 nonsense mutation;positive desmin(incomplete mucosal muscle);positive Syn in individual cells;positive CgA in individual cells;positive CD31 and D2-40(no tumor thrombus in the vessel);10%positivity for Ki-67.Conclusion GA-FG is a new histological type of gastric cancer with unique clinical endoscopic and pathological features.The prognosis of GA-FG is good,but a long-term follow-up is needed.

关 键 词：胃肿瘤 胃底腺型胃癌 内窥镜检查 消化系统 隆起型病变 

分 类 号：R735.2[医药卫生—肿瘤]