十二指肠腺导管腺瘤伴上皮内瘤变2例  

Two cases of duodenal ductal adenoma with intraepithelial neoplasia

作　　者：王波 乔丽 刘海阳 叶涛 陈忠光 WANG Bo;QIAO Li;LIU Haiyang;YE Tao;CHEN Zhongguang(Department of Pathology,Linyi Central Hospital,Linyi 276000,China;Department of Oncology,Linyi Central Hospital,Linyi 276000,China;Department of Surgery,Linyi Central Hospital,Linyi 276000,China;Department of Pharmacy,Linyi Central Hospital,Linyi 276000,China)

机构地区：[1]临沂市中心医院病理科,山东临沂276000 [2]临沂市中心医院肿瘤科,山东临沂276000 [3]临沂市中心医院外科,山东临沂276000 [4]临沂市中心医院药学部,山东临沂276000

出　　处：《老年医学研究》2025年第2期63-65,共3页Geriatrics Research

摘　　要：患者2例,均为女性,年龄分别为69岁和67岁,十二指肠内镜检查均见隆起性病变。镜下均见黏膜肌层内中央扩张的腺管,被覆高柱状上皮细胞,局灶呈乳头状生长,部分区域呈假复层生长方式,细胞核多位于基底部,间质见淋巴细胞、浆细胞浸润。病例1部分区域核异型较明显,细胞核增大,核浆比增大,核仁显著,细胞核极性消失,腺腔表面见异型细胞核,核分裂象易见,腺体结构扭曲,个别腺体见背靠背排列。病例2局部区域细胞核轻度增大、深染,呈杆状,细胞核分裂象可见,腺体结构拥挤。病例1、2免疫组织化学染色:瘤细胞MUC5AC阳性,CDX2、MUC2、CD56、CgA、Syn、S-100均阴性,Ki-67增殖指数分别为20%和5%。病例1诊断为十二指肠腺导管腺瘤伴高级别上皮内瘤变,病例2诊断为十二指肠腺导管腺瘤伴低级别上皮内瘤变。均行胃镜下黏膜病灶切除术治疗,预后良好。Two patients,both female,aged 69 and 67 years,showed elevated lesions by duodenal endoscopy.Under the microscope,the central expansion of the gland tube in the mucosal muscle layer was covered with high columnar epithe-lial cells,focal papillary growth,and some areas showed a pseudostratified growth mode.Most nuclei were located at the base,and lymphocyte and plasma cell infiltration were seen in the stroma.In case 1,some areas had enlarged nuclei,en-larged nucleo-to-cytoplasm ratio,significant nucleoli,disappeared nuclear polarity,heterogeneous nuclei on the surface of the gland cavity,visible nuclear division,distorted gland structure,and back-to-back arrangement of some glands.In case 2,the nucleus was mildly enlarged and deeply stained,with visible nuclear division and crowded glandular structure.Immunohistochemical staining in cases 1 and 2:tumor cells were positive for MUC5AC,negative for CDX2,MUC2,CD56,CgA,Syn,and S-100,and the Ki-67 proliferation index was 20%and 5%,respectively.Case 1 was diagnosed as duodenal ductal adenoma with high-grade intraepithelial neoplasia,and case 2 as duodenal ductal adenoma with low-grade intraepithelial neoplasia.Both were treated with endoscopic mucosal lesion resection,with good prognosis.

关 键 词：十二指肠 导管腺瘤 上皮内瘤变 MUC5AC CDX2 MUC2 

分 类 号：R735.3[医药卫生—肿瘤]