消化道幽门腺腺瘤的临床、内镜及病理特征分析  

Pyloric gland adenoma:clinicopathological and endoscopic analysis of 14 cases in gastrointestinal tract

作　　者：董宁宁[1] 孟凡冬[1] 岳冰[2] 侯俊珍 Dong Ningning;Meng Fandong;Yue Bing;Hou Junzhen(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,State Key Laboratory for Digestive Health,National Clinical Research Center for Digestive Disease,Beijing Digestive Disease Center,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases,Beijing 100050,China;Department of Pathology,Beijing Friendship Hospital of Capital Medical University,Beijing 100050,China;Department of Gastroenterology,Shijingshan teaching hospital of Capital Medical University,Beijing Shijingshan Hospital,Beijing 100040,China)

机构地区：[1]首都医科大学附属北京友谊医院消化分中心消化健康全国重点实验室,国家消化系统疾病临床医学研究中心,北京市消化疾病中心消化疾病癌前病变北京市重点实验室,北京100050 [2]首都医科大学附属北京友谊医院病理科,北京100050 [3]首都医科大学石景山教学医院北京市石景山医院消化内科,北京100040

出　　处：《中华胃肠内镜电子杂志》2024年第3期159-165,共7页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

基　　金：国家自然科学基金面上项目(82070575)

摘　　要：目的探讨消化道幽门腺腺瘤(PGA)的临床、内镜、病理特征及治疗效果。方法回顾性分析2020年1月至2023年12月首都医科大学附属北京友谊医院经病理组织学确诊的消化道PGA患者14例,对其临床病理特征、内镜特征及治疗效果进行总结。结果14例消化道PGA患者中,女9例、男5例,中位年龄63岁。PGA缺乏特异性临床表现,病变平均最大直径19 mm,多见于胃,其次是十二指肠球部。根据巴黎分型,10例表现为0-Ⅰ型、3例为0-Ⅱa型、1例为0-Ⅱb型。10例胃PGA背景黏膜包括自身免疫性胃炎、幽门螺杆菌相关性胃炎、家族性腺瘤性息肉病;4例十二指肠PGA周围均存在异位胃黏膜。治疗上12例(85.7%)行内镜下切除术,均完整切除病变,无严重并发症。组织学上5例(35.7%)伴高级别异型增生;免疫组化显示腺体同时表达MUC6和MUC5AC。结论消化道PGA好发于老年女性,常见于自身免疫性胃炎、幽门螺杆菌相关性胃炎及十二指肠异位胃黏膜上,临床及内镜下表现均缺乏特异性,需要内镜及病理医生提高对本病的认知,早期诊断并行内镜下治疗可取得良好预后。Objective To summarize the clinicopathological and endoscopic characteristics and treatment outcome of pyloric gland adenoma(PGA)in gastrointestinal tract.Methods 14 patients who were pathologically diagnosed as PGA in gastrointestinal tract in Beijing Friendship Hospital,Capital Medical University was retrospectively analyzed.Results Among the 14 patients,nine were female(64.3%)and five were male(35.7%),with the median age of 63 years old(range,40 to 78 years).All 14 PGAs were solitary,with the average maximum diameter of 19 mm(range,4-45 mm).Ten lesions located in the stomach(71.4%)(including six lesions in gastric body,three lesions in the fundus and one lesion in the antrum)and four lesions in the duodenal bulb(28.6%).Most patients were asymptomatic.Endoscopically,according to Paris classification,ten lesions(71.4%)were classified as type 0-I,three lesions(21.4%)as type 0-Ⅱa,and one lesion(7.1%)as type 0-Ⅱb.Regarding the background mucosa,among the ten gastric PGAs,five cases were autoimmune gastritis,four cases were Helicobacter Pylori-associated gastritis,and one case was familial adenomatous polyposis;meanwhile ectopic gastric mucosa was found around all the four duodenal PGAs.In terms of treatment,12 cases(85.7%)were treated with endoscopic resection,all of which were completely resected without any serious complications.Histologically,PGAs were composed of compact tubules of pyloric phenotype,wherein five cases(35.7%)were accompanied by high-grade dysplasia.All PGAs expressed MUC6 and co-expressed MUC5AC.Conclusions PGAs in gastrointestinal tract were frequently found in the background mucosa of autoimmune gastritis,Helicobacter Pylori-associated gastritis and ectopic gastric mucosa.They were mostly asymptomatic and more common in elderly women.There were no specific endoscopic manifestations,so endoscopists and pathologists need to improve their recognition of PGA.Early diagnosis and endoscopic treatment can lead to a good prognosis.

关 键 词：幽门腺腺瘤 胃 十二指肠 临床病理特征 内镜特征 内镜下切除术 

分 类 号：R735[医药卫生—肿瘤]