胃倒置性增生性息肉伴癌变1例并文献复习  

Inverted hyperplastic polyp of the stomach with carcinogenesis transformation:A case report and literature review

作　　者：吴建龙[1] 郁葱颖[1] 花海洋[2] 刘海丽[1] 王学文[1] 付昌鸿 WU Jianlong;YU Congying;HUA Haiyang;LIU Haili;WANG Xuewen;FU Changhong(Department of Pathology,Chengde Central Hospital,Chengde Hebei 067000;Department of Gastroenterology,Chengde Central Hospital,Chengde Hebei 067000;Fu Debao Clinic,Lingshou County,Shijiazhuang 050500,China)

机构地区：[1]承德市中心医院病理科,河北承德067000 [2]承德市中心医院消化内科,河北承德067000 [3]灵寿县付德保诊所,石家庄050500

出　　处：《临床与病理杂志》2024年第11期1613-1618,共6页Journal of Clinical and Pathological Research

摘　　要：胃倒置性增生性息肉(inverted hyperplastic polyp,IHP)较为罕见,患者无明显的临床症状,且其诊断相对困难。报告1例IHP伴癌变的病例并复习相关文献。患者,女,68岁,内镜发现胃底部一隆起性病变,大小约为4 cm×5 cm,表面凹凸不平,粗糙颗粒样,有透明胶冻样黏液附着。显微镜下见黏膜间质淋巴细胞及浆细胞浸润,黏膜肌及黏膜下见广泛的小凹上皮下陷,腺管扩张,呈息肉样增生,局部与黏膜表面相连,黏膜下层可见增生的幽门腺,部分黏膜下腺体呈高级别异型增生,局部癌变。免疫组织化学结果:黏膜下胃小凹上皮黏蛋白(mucin,MUC)5AC抗体标志阳性,增生的幽门腺表达MUC6。病理诊断:IHP,部分黏膜下腺体呈高级别异型增生,局部癌变,未见明确脉管内癌栓,水平及基底切缘未见上皮内瘤变。IHP在胃部比较少见,内镜下表现不具有特征性,黏膜切除标本在显微镜下具有特征的组织学形态,行病理诊断的同时也要做好鉴别诊断,深在性囊性胃炎和高分化管状腺癌都是其鉴别对象,若分泌黏液还需要与异位的胰腺导管内乳头状黏液肿瘤相鉴别。Inverted hyperplastic polyp(IHP)of the stomach is a rare condition,typically presenting without obvious clinical symptoms,making its diagnosis challenging.This study retrospectively analyzes a case of IHP with carcinomatous transformation diagnosed at Chengde Central Hospital,along with a literature review.The patient was a 68-year-old female who was found on endoscopy to have a raised lesion in the gastric fundus,measuring approximately 4 cm×5 cm,with an irregular surface,coarse granular texture,and adherent transparent gelatinous mucus.Histopathological examination revealed lymphocyte and plasma cell infiltration in the mucosal stroma,extensive downward displacement of foveolar epithelium into the muscularis mucosae and submucosa,glandular dilation with polypoid hyperplasia,and focal connection to the mucosal surface.Hyperplastic pyloric glands were present in the submucosa,with some areas exhibiting high-grade dysplasia and focal carcinomatous transformation.Immunohistochemical staining showed positive mucin(MUC)5 AC expression in the submucosal gastric foveolar epithelium,while hyperplastic pyloric glands expressed MUC 6.Pathological diagnosis:IHP with focal high-grade dysplasia and carcinomatous transformation,with no clear vascular invasion,and no intraepithelial neoplasia was observed in the horizontal or basal margin.IHP is relatively rare in the stomach,and its endoscopic features are non-specific.However,its histopathological characteristics in mucosectomy specimens are distinctive.Pathological diagnosis should be accompanied by differential diagnosis,particularly distinguishing it from deep cystic gastritis and well-differentiated tubular adenocarcinoma.If mucin secretion is observed,differentiation from ectopic intraductal papillary mucinous neoplasm of the pancreas should also be considered.

关 键 词：胃倒置性增生性息肉 癌变 免疫组织化学 临床病理特征 鉴别诊断 

分 类 号：R735.2[医药卫生—肿瘤]