34例早期胃癌患者的临床病理分析

作者报道了３４例早期胃癌患者的临床病理特点，并结合其特点，对内窥镜检查和病理活检中漏诊病例作一分析。     

小儿经口小肠粘膜活检技术——附122例次活检经验

本文应用小儿Crosby—Kuglar小肠活检器,对101例患儿进行了122例次的小肠粘膜活检检查,结果显示107例次(86.9％)成功检出肠粘膜组织,约3×3mm~2大小,一般局限于粘膜层。失败者16例,其主要原因为活检器未检到组织和未过幽门。仅1例出现轻微出血并发症。结论:采用Crosby小肠活检器进行小肠粘膜活检是一种安全、可靠的临床检查方法,有利于深入研究小肠的生理及病理。     

活检消失的胃微小类癌一例

患者,女 61岁, 20天前上腹呈持续烧灼样疼痛,伴腹胀、恶心、呕吐。呕吐胃内容物后呕鲜血 80ml,并黑便 5次,胃镜见胃体部小息肉,病理诊断胃类癌收外科住院。 25年前患慢性胃扭转,手法复位治疗;甲亢、糖尿病 20年,目前使用胰岛素治疗, 3年前患“房颤”。体检无阳性发现,腹部无外科情况。 　　化验指标： WBC 4 500, BPC 17.5万, Hb 99g/L,,尿常规 (－ ),糖 (－ )～（＋＋）,血糖 106～ 132mg％, GPT 28u/L, PTA 76％, HBsAg(－ ),A/G 3.8/1.7,铁蛋白 192ng/ml。血气分析正常, EKG正常, BUS(－ ),肝、胆、胰…     

603例胃高位病变的临床观察

对内镜及病理确诊的603例胃高位病变和1106例胃窦部病变进行对照分析,发现胃高位病变有如下特点:①平均年龄大,老年人居多;②发病的性别差别明显高于胃窦病变;③贲门部位的隆起及浸润病变常有吞咽阻挡感,且多为恶性;④胃体上部后壁溃疡70%为恶性,而小弯溃疡仅19%;⑤高位溃疡≥4cm者几乎都是恶性;⑥X线极易漏误诊,诊断符合率仅32.6%;⑦内镜是确诊的主要手段,但必须提高诊断技巧。     

14例早期胃癌的临床病理分析

１４例早期胃癌的临床病理分析邱荣星，张建国为不断加深对早期胃癌的认识，提高早期胃癌的发现率，现对我院近１０年发现的１４例早期胃癌作临床病理分析。材料和方法对１４例早期胃癌病史，病理切片复审及调查预后，其中１１例胃切除标本被采取连续取材石蜡切片ＨＥ染色...     

大肠粘膜腺管开口对粘膜病变的诊断价值

目的：探讨放大内镜结合腺管开口分型在诊断大肠粘膜病变性质的临床应用价值。方法：放大内镜检查中，发现病变后，对病灶喷洒靓胭脂，采用放大内镜观察病灶粘膜腺管开口形态，按Kudo分型作病灶性质判断 ，并与切除或活检组织作病理学比较。结果：在194处病灶中，放大内镜诊断为炎性息肉、管状腺瘤、绒毛状腺瘤和大肠癌的病理符合率分别为100.0％、93.3％、90.9％、100.0％，总病理符合率为96.1％。结论：放大内镜对判断大肠病变性质有较高的病理符合率，使我们能够区分肿瘤与非肿瘤，良性与恶性肿瘤，预测癌的浸润深度，决定合适的治疗方式，具有较高的临床应用价值。     

韩国早期胃癌的临床病理特征

尽管胃癌的发病率在不断下降，胃癌仍然是引起死亡的癌症中最常见的一种。相对而言，局限于粘膜和粘膜下组织的早期胃癌，无论有没有淋巴结的转移，一般都有较好的预后。西方及日本的研究结果均表明，近年来早期胃癌成增长趋势，并将此归因于诊断手段的进步，特别是内窥镜目标活检的应用。本研究通过回顾汉城Yousei大学医学院康复医院从1976～1995年间的胃癌病例，旨在获得韩国早期胃癌的临床病理特征。     

Multiple Early Gastric Carcinoma in Cases Treated Endoscopically

Multiple gastric carcinoma was endoscopically diagnosed in 14 patients (13.6%) with 33 lesions (27.3%), out of 103 cases of early gastric carcinoma treated by endoscopic surgery. The sex ratio of these patients was 11 males to 3 females, and their mean age was 61.7 years old. In 79% of the patients the macroscopic type of the lesions was the same. Twelve of 33 lesions were metachronous lesions diagnosed by endoscopy using the dye contrast method. All of the metachronous lesions were evaluated as invading only as far as the mucosa. Almost all of the metachronous lesions were located at a height similar to that of the initial lesion or in a more oral direction. Eleven of 12 metachronous lesions were less than 2 cm in diameter, including 5 minute cancer lesions which were less than 5 mm in size. All these lesions were treated again endoscopically without gastrectomy. These results suggest that an annual endoscopy using the dye contrast method permits early detection of gastric carcinoma at a stage at which it can be treated endoscopically.     

经内镜美蓝染色对早期胃癌的诊断价值

目的：探讨美蓝染色对胃良恶性病变的定性及判定癌浸润深度的价值。方法：将０．３％美蓝用喷洒管经内镜直接在病变处喷洒染色。结果：５３例中Ⅰ型６例,Ⅱａ型６例,Ⅲａ＋Ⅱｃ型４例,Ⅱｃ型４例,Ⅱｃ型６例,Ⅲ型１９例,Ⅱｃ＋Ⅲ型１２例;粘膜内癌２４例,粘膜下癌２９例。     

Expression of Tumor-Associated Antigens on Gastric Biopsy Materials

Abstract: We investigated the expressions of SLX, ST-439 and PLAP, which are regarded as having high specificity for cancer, in borderline lesions of the stomach to ascertain the significance of these potential markers in distinguishing between benign and malignant lesions. SLX, ST-439 and PLAP expressions in gastric biopsy specimens, from 73 patients with gastric lesions, were visualized using avidin-biotin-peroxidase. Although the prevalence of SLX in Group V was 90%. it was also high in intestinal metaplasia (40%) and adenoma (75%). The prevalences of ST-439 in intestinal metaplasia and adenoma grades l and 2 were 5, 23, and 17%. respectively. On the other hand, the prevalence of ST-439 was about 60% in adenoma grade 3 and in Groups IV and V. The prevalence and immunostaining range of ST-439 increased concomitantly with increasing grades of cytological and architectural atypia. The prevalence of PLAP in gastric biopsy materials was 30% overall, but was higher among the differentiated types. Moreover, PLAP was highly specific for cancer because of the negative immunostaining observed in benign lesions such as intestinal metaplasia and adenoma. These results suggest the following: 1) SLX is relatively non-specific for cancer and thus not useful in the pathological diagnosis of gastric lesions, and 2) borderline lesions with positive ST-439 mandate careful follow-up. Moreover, lesions with apparently extensive and intense ST-439 immunostaining may be gastric cancer and require urgent attention. Furthermore, 3) PLAP may provide additional diagnostic information useful for distinguishing between well-differentiated adenocarcinoma and borderline lesions including adenoma.     

消化道混合性腺神经内分泌癌9例病理形态观察

目的分析消化道混合性腺神经内分泌癌的病理形态特征,探讨其诊断要点。方法对确诊为混合性腺神经内分泌癌的消化道手术切除标本9例进行光镜观察和突触素(Syn)、嗜铬粒蛋白(CgA)、癌胚抗原(CEA),细胞角蛋白8/18(CK8/18),Ki-67等5种抗体免疫组织化学染色,并复习其临床资料.结果镜下可见具有腺癌特征和神经内分泌肿瘤特征的两种区域,各种标志物的免疫组化染色阳性比率:CEA及CK8/18全部阳性(9/9,100%),Syn阳性6例(6/9,66.7%),CgA阳性5例(5/9,55.6%)。结论消化道混合性腺神经内分泌癌临床上比较少见,形态学上与常见的低分化腺癌不易区分,需要依靠免疫组化检测进行区分,其预后较一般腺癌差。     

Upgrade of Lesions Initially Diagnosed as Low-Grade Gastric Dysplasia upon Forceps Biopsy Following Endoscopic Resection

Background/Aims

Gastric dysplasia is generally accepted to be the precursor lesion of gastric carcinoma. Approximately 25% to 35% of histological diagnoses based on endoscopic forcep biopsies for gastric dysplastic lesions change following endoscopic resection (ER). The aim of this study was to determine the predictive endoscopic features of high-grade gastric dysplasia (HGD) or early gastric cancer (EGC) following ER for lesions initially diagnosed as low-grade dysplasia (LGD) by a forceps biopsy.

Methods

To determine predictive variables for upgraded histology (LGD to HGD or EGC). The lesion size, gross endoscopic appearance, location, and surface nodularity or redness as well as the presence of a depressed portion, Helicobacter pylori infection, and intestinal metaplasia were retrospectively investigated.

Results

Among 251 LGDs diagnosed by an initial forceps biopsy, the diagnoses of 100 lesions (39.8%) changed following the ER; 56 of 251 LGDs (22.3%) were diagnosed as HGD, 39 (15.5%) as adenocarcinoma, and 5 (2.0%) as chronic gastritis. In a univariate analysis, large lesions (>15 mm), those with a depressed portion, and those with surface nodularity were significantly correlated with a upgraded histology classification following ER. In a multivariate analysis, a large size (>15 mm; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.46 to 5.43) and a depressed portion in the lesion (OR, 2.7; 95% CI, 1.44 to 5.03) were predictive factors for upgraded histology following ER.

Conclusions

Our study shows that a substantial proportion of diagnoses of low-grade gastric dysplasias based on forceps biopsies were not representative of the entire lesion. We recommend ER for lesions with a depressed portion and for those larger than 15 mm.     

早期胃癌的胃镜下特点——附78例临床分析

目的分析早期胃癌的临床病理特征,提高早期胃癌的检出率。方法总结我院2004年～2006年经术前胃镜检查及活检,后全部经手术与病理证实为早期胃癌的78例患者的临床病理特征。结果 78例早期胃癌发病高峰年龄为50-59岁,胃窦和胃角是好发部位,各30例(33.33%),病理以Ⅱc型最多,为40例(51.28%),管状腺癌最多,为54例(69.23%)。结论早期胃癌临床无特异性症状,需认真对胃镜及病理结果分析,才能提高早期胃癌的检出率。     

A Case of Extensive Gastrointestinal Involvement of Malignant Lymphoma Associated with Early Gastric Carcinoma

Abstract: Described is a 59 year old Japanese man With malignant lymphoma involving the stomach, duodenum, terminal ileum, colon and rectum, who developed early gastric carcinoma. Repeated gastroduodenoscopy revealed various appearances of the gastrointestinal involvement in malignant lymphoma, such as giant folds, polypoid lesions, and ulcerations, in addition to a depressed lesion of early gastric carcinoma. Colonoscopy also showed multiple polypoid lesions throughout the large bowel. Though the gastrointestinal involvement in malignant lymphoma is not rare, diffuse multiple polypoid lesions in the entire large bowel as seen in our case have rarely been endoscopically described. The coexistance of malignant lymphoma and gastric carcinoma in our case might be only a coincidence, though some reports of an increasing incidence of second tumors in patients with malignant lymphoma have been published. Further consideration will be needed as to the relationship between malignant lymphoma and the occurence of a second malignancy.     

A Case of Early Gastric Carcinoma with Lymphoid Stroma: Diagnostic Usefulness of Endosonography

Abstract: A case of early gastric carcinoma with lymphoid stroma (GCLS) showing features of submucosal tumor is reported here. A characteristic endoscopic ultrasonographic (EUS) finding was helpful for preoperative diagnosis. The patient, a 75-year-old woman without any previous complaints, visited our hospital for detailed examination of a small gastric lesion. Upper Gl studies revealed a submucosal tumor-like lesion measuring about 1.8 cm with a central slight depression on the greater curvature of the middle gastric body. Histologic findings of the specimens obtained by conventional biopsy indicated a poorly differentiated adenocarcinoma, although the possibility of malignant lymphoma was not completely ruled out. EUS examination was, therefore, performed in order to obtain further detailed information about the tumor. EUS disclosed that the tumor, which existed in the third layer, was composed of many small round clustered lesions, the echogenicity of which was lower than that of the muscle layer, and was almost covered with a normal mucosal layer. Taking these findings into consideration, a gastric cancer with lymphoid stroma whose invasion would be limited within the submucosa was highly suspected. It was proven by histological analysis of a surgically resected specimen that this peculiar multiple small round hypoechoic lesion was equivalent to the lymphoid aggregates infiltrating the GCLS. Since it has been reported that the prognosis of GCLS is better than that of common gastric cancers, accurate diagnosis is important for the selection of optimal treatment. While it is still not definitively proven that EUS is useful for diagnosis of GCLS, this procedure may potentially provide an excellent image of this special tumor and be of use for preoperative diagnosis.     

三九胃泰颗粒对大鼠急性胃粘膜损伤的修复作用

目的 :观察三九胃泰颗粒对胃粘膜损伤修复和细胞增殖活性调控的影响。方法 :采用无水乙醇 1m l胃饲诱发急性胃粘膜损伤大鼠模型并用三九胃泰颗粒治疗 ,免疫组织化学技术检测胃上皮细胞的增殖改变 ,早期应答基因 c- jun和 c- met的表达。结果 :三九胃泰颗粒、胃舒颗粒、养胃冲剂及丽珠得乐治疗组大鼠胃粘膜损伤指数均显著低于无水乙醇模型组及自然恢复组 ,尤以三九胃泰颗粒治疗后为甚 (P <0 .0 5 ) ;免疫组织化学显示三九胃泰颗粒、胃舒颗粒、养胃冲剂及丽珠得乐治疗组大鼠胃粘膜增殖细胞核抗原标记的阳性细胞数量、c- jun和 c- met的阳性表达均有高于无水乙醇模型组及自然恢复组的趋势 ,尤以三九胃泰颗粒治疗后为甚 (P <0 .0 5 )。结论 :三九胃泰颗粒能促进急性胃粘膜损伤的修复     

丹参抗大鼠乙醇性胃粘膜损伤的作用及机制

目的 :探讨丹参抗大鼠乙醇性胃粘膜损伤的作用及机制。方法 :采用 10 0 %乙醇复制大鼠乙醇性胃粘膜损伤模型 ,用放射免疫法测定胃粘膜内前列腺素 E2 (PGE2 )、前列腺素 I2 (PGI2 )的含量 ,用浓盐法测定胃粘膜内DNA的含量。结果 :丹参组的胃粘膜损伤指数低于对照组 (P <0 .0 1) ;胃粘膜内 PGE2 、PGI2 含量高于对照组 (均 P<0 .0 1) ;DNA含量高于对照组 (P <0 .0 1)。结论 :丹参促进胃粘膜细胞 DNA的合成和胃粘膜细胞的增殖 ,使PGE2 、PGI2 含量增加 ,进而促进了胃粘液的分泌。