胃肠道错构瘤性内翻性增生性息肉10例临床病理学分析  

Gastrointestinal hamartomatous inverted hyperplastic polyps:a clinicopathological analysis of ten cases

作　　者：孟琳 郭勇 赵芯 陈玲 贾旭春 李增山 张丽英 Meng Lin;Guo Yong;Zhao Xin;Chen Ling;Jia Xuchun;Li Zengshan;Zhang Liying(Department of Pathology,the First Affiliated Hospital of Air Force Medical University,Xi′an 710032,China;Department of Pathology,Baoji Central Hospital,Shaanxi Province,Baoji 721000,China;Department of Gastroenterology,the First Affiliated Hospital of Air Force Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院病理科,西安710032 [2]陕西省宝鸡市中心医院病理科,宝鸡721000 [3]空军军医大学第一附属医院消化内科,西安710032

出　　处：《中华病理学杂志》2025年第2期142-148,共7页Chinese Journal of Pathology

摘　　要：目的探讨胃肠道错构瘤性内翻性增生性息肉(HIHP)的临床病理特征、诊断、不同组织学分型的基因改变及生物学行为。方法收集2013年1月至2024年3月空军军医大学第一附属医院诊断的10例HIHP的临床、超声、内镜及病理学资料,分析其临床病理特征、组织学形态,并对组织学进一步分为3个亚型,分析不同组织学分型与预后的关系。结果10例患者男性5例、女性5例;发病年龄为45~68岁,中位年龄为60.5岁;发生部位分别为:2例胃底、6例胃体、1例胃窦、1例十二指肠;消化内镜下为黏膜隆起性病变,1例(病例10)表面可见浅凹陷,病变最大径范围0.5~2.5 cm;超声内镜可呈多房囊性低密度影,分隔强化表现(病例4);临床术前诊断为息肉、异位胰腺或胃肠道间质瘤。组织学亚型分型2例有1型形态(与黏膜相通,有清晰的平滑肌边界),病例10有明确开口形成花瓶样形态,而病例4与表面黏膜无明显开口;3例2型形态(不与黏膜相通,有清晰的平滑肌边界);5例3型形态(不与黏膜相通,无清晰的平滑肌边界或增生的平滑肌分隔增生的腺体呈小叶结构),其中包括1例十二指肠病变(病例9),病变区内均为胃型腺体增生、扩张。病变区内腺体包含胃小凹、胃底腺及幽门腺,不同程度排列组合,伴随平滑肌增生。病例10间质合并平滑肌细胞瘤样增生,病例2及4腺体结构及细胞形态有不典型性,但免疫组织化学p53呈野生型表达模式及Ki-67阳性指数<1%,提示为炎症刺激后反应性不典型性改变。对3例不同分型(1型病例4、2型病例2、3型病例9)的HIHP进行了二代测序,结果显示3例有不同的基因突变,并未得出一致性基因改变。随访共1~130个月均无病生存。结论HIHP呈良性经过,未检测到一致性基因改变。消化道息肉样病变种类复杂,尤其是HIHP的1型和3型有独特的大体外观及镜下特点,需结合内镜、正确取材方式,以期诊断时明确该�Objective To investigate the clinicopathological features,diagnosis,genetic alterations,and biological behaviors of hamartomatous inverted hyperplastic polyp(HIHP)in the gastrointestinal tract.Methods The clinical,sonographic,endoscopic and pathologic data of 10 HIHP cases diagnosed at the First Affiliated Hospital of Air Force Medical University,Xi′an,China from January 2013 to March 2024 were collected.Their clinicopathological features and histological morphology were analyzed.The cases were further divided into 3 histologic subtypes.Follow-up information was collected to analyze the relationship between histological subtype and prognosis.Results There were 5 males and 5 females in this cohort.The age of onset was 45-68 years,with a median age of 60.5 years.The polyp-involved sites included 2 cases in gastric fundus,6 cases in gastric body,1 case in gastric antrum,and 1 case in duodenum.Digestive endoscopy showed mucosal protrusion lesions in all cases,except 1 case(case 10)of shallow depression on the surface,with the maximum diameter ranging 0.5-2.5 cm.Endoscopic ultrasonography showed multilocular cystic low-density shadows,with septal enhancement(case 4).The preoperative clinical diagnosis was gastric polyp,ectopic pancreas or gastrointestinal stromal tumor.Two cases showed type 1 morphology(i.e.,connected with the mucosa,with clear smooth muscle boundaries).One of them(case 10)had a clear opening to form a vase-like morphology,while the other(case 4)had no obvious opening with the surface mucosa.Three cases showed type 2 morphology(i.e.,not connected with the mucosa,with clear smooth muscle boundaries).Five cases showed type 3 morphology(i.e.,not connected with the mucosa,without clear smooth muscle boundaries or hyperplastic smooth muscle that separated hyperplastic glands showing lobular configuration).Among them,one case of duodenal lesions(case 9)showed gastric type gland hyperplasia and expansion,including gastric fossa,gastric fundic gland and pyloric gland,with various arrangement and combination

关 键 词：胃肠疾病 错构瘤 息肉 

分 类 号：R735[医药卫生—肿瘤]