胃癌活检或标本相关的Laurén和世界卫生组织分类的区别

胃癌形态学上显示出大量组织病理学分化的变异。在其各种分类系统中 ,应用最为广泛的是由Ｌａｕｒ啨ｎ及世界卫生组织 (ＷＨＯ)提出的分类。胃癌中胃切除范围取决于肿瘤大小、肿瘤位置、侵袭的深度和根据Ｌａｕｒ啨ｎ组织学划分的肠型和弥漫型。该结果是以内镜活检所鉴定的术前组织病理学诊断为基础。本研究的目的在于重新调查胃癌术前内镜活检按照Ｌａｕｒ啨ｎ和ＷＨＯ的组织学分类的准确性 ,为此 ,我们独立复查了通过术前活检取得的胃癌组织 ,并与切除标本的组织学诊断结果进行了对比。材料和方法　本项回顾性形态学研究包括 1 0 0名连续…     

胃镜及CT检查对进展期胃癌手术可切除性的探讨

目的 探讨胃镜结合CT检查对进展期胃癌的术前分期及手术治疗的临床指导意义.方法 对182例进展期胃癌的术前胃镜并CT分期与手术结果进行对比.结果 胃镜活检低(未)分化腺癌和黏液腺癌手术切除率(64.1%)较低,弥漫浸润型胃癌的切除率(6.7%)明显低于肿块型(66.7%)和溃疡型(61.8%);CT分期总准确率为91.21%,CT诊断对胃周脏器受侵和(或)转移的敏感性为72.22%,CT对淋巴结分期的准确率为74.2%,敏感性为74.1%,特异性为74.3%,CT诊断对淋巴结分组比较模糊.结论 胃镜在进展期胃癌定性诊断方面有不可取代的优势,对进展期胃痛的大体分型和活检组织学诊断及治疗方式有指导意义.CT诊断对进展期胃癌的临床分期准确性对周围脏器的侵犯、转移及淋巴结转移的诊断均有很高的价值;CT对手术切除情况的判断优于胃镜检查.术前行CT检查,对手术治疗有重要指导意义.     

胃癌术前内镜超声检查与肿瘤血管内皮生长因子表达的检测分析

目的探讨内镜超声检查(EUS)对胃癌术前诊断和分期的应用价值及其影像学改变与肿瘤转移相关基因表达的分子生物学基础。方法联合应用电子胃镜和超声内镜诊断胃癌63例,对比胃镜检查加活检与超声内镜对胃癌诊断的准确率,同时应用超声内镜对胃癌进行术前分期,并与病理分期及血管内皮生长因子(VEGF)表达进行比较。结果63例胃癌中胃镜加病理活检诊断的准确率是94%,超声内镜诊断的准确率是92%,胃镜联合超声内镜诊断的准确率是100%。超声内镜对胃癌侵犯深度判断的准确率为81%,其中T1期为78%、T2期为79%、T3期为82%、T4期为83%,对淋巴结转移的准确率为73%。VEGF蛋白在胃癌组织中的阳性表达率为56%,其表达与EUS分期、淋巴结转移关系密切(P<0.05)。结论胃镜联合超声内镜诊断胃癌具有较高的准确率;胃癌术前内镜超声分期与术后病理有较高的一致性;VEGF蛋白表达与胃癌术前EUS分期呈正相关;EUS对胃癌的分期与分子生物学改变有关。     

早期胃癌淋巴结转移的一般型式

在1963～1987年期间，日本Sapporo－Kosei医院外科曾施行了1318例早期原发性胃癌切除手术，除去多发性癌灶、非上皮性癌肿和记录不详的病例外，仅对余下的1137例进行分析，计男女之比为2：1岁，平均59．3岁，病变限于粘膜或粘膜下层。肿瘤的纵位分为上、中和下1／3部，水平位分为大小弯和前后壁。肉眼外观按日本胃肠内镜学会分类，综合为隆起、凹陷和混合型三大类。病理标本按Lauren分类法分成肠型或弥漫型，淋巴结转移分14组记录，其中l～6组列为冒周淋巴结。结果：（一）肿瘤的位置、大体和镜检类型在全组1137例中，575例为粘膜型，562…     

转录抑制因子Snail表达与胃癌Lauren分型的关系研究

目的探讨转录抑制因子Snail表达与胃癌Lauren分型的关系。方法Western印迹检测肠型胃癌细胞系（N87）和弥漫型胃癌细胞系（AGS）中Snail和上皮型E钙黏蛋白（E-cadherin）的表达。将糖原合酶激酶．3B（GSK-3B）质粒转染胃癌细胞系,检测Snail和E-cadherin的表达变化。收集2000年2月至2005年12月间在复旦大学附属中山医院行胃癌根治术的77例术后组织标本．采用免疫组织化学染色检测Snail在胃癌组织中表达．并分析其与胃癌Lauren分型之间的关系。结果Snail在N87中低表达,在AGS中高表达;E-cadherin表达与Snail相反。转染GSK-3B后,胃癌细胞Snail表达显著下调,E-cadherin表达显著上调（P〈0．01）。使用不同浓度的GSK-3B抑制剂氯化锂处理后．胃癌细胞Snail表达显著上调,且具有明显浓度依赖性（P〈0．01）。21例肠型胃癌中Snail低表达16例,高表达5例;56例弥漫型胃癌中Snail低表达21例,高表达35例;肠型胃癌中Snail表达明显弱于弥漫型,差异有统计学意义（P〈0．01）。结论Snail的表达与胃癌Lauren分型有关．是一种潜在的确定胃癌分型的分子标志物。     

特殊形态的胃黏液腺癌一例

胃黏液腺癌是一种少见的胃癌组织学类型, 其大体分型多为隆起型, 内镜发现时多已是进展期, 且病变的活检病理诊断稍困难。本例进展期胃黏液腺癌的内镜下表现形态极为特殊, 呈蜂窝空洞样, 明显不同于常见进展期胃癌形态, 而且病理提示为单纯的黏液腺癌, 未见中高分化胃癌及其他未分化癌组织细胞成分, 同时多次、多部位活检后仍难以明确病理性质。此类病例鲜有文献报道。     

EB病毒相关性胃癌肿瘤免疫微环境研究进展

正根据最新的全球肿瘤流行病统计数据(GLOBOCAN),胃癌是世界第三大肿瘤致死原因,而我国所在的东亚地区更是胃癌高发地区~([1-2])。由于胃癌的肿瘤异质性大,其相关科学研究及临床治疗决策面临着巨大的挑战。以往常用的病理学分型方法主要包括Lauren分型(肠型和弥漫型)和WHO分型(腺癌、鳞癌、未分化癌等),但随着肿瘤分子生物学及肿瘤免疫学的发展,上述传统的分类方法已无法适应目前所提倡的胃癌精准治疗理念~([3])。近来,根据肿瘤     

趋化因子受体CCR7在胃癌中的表达及其与淋巴结转移的关系

目的探讨趋化因子受体CCR7的表达对预测胃癌淋巴结转移的临床价值。方法对132例行胃癌根治术和30例内镜活检的胃癌组织标本采用免疫组化法检测CCR7的表达。结果CCR7在56.8%的病例中呈阳性表达。CCR7在伴有淋巴结转移病例中的表达显著高于无淋巴结转移者(P<0.001);其与肿瘤大小(P<0.01)、浸润深度(P<0.001)、淋巴管浸润(P<0.001)和TNM分期(P<0.001)相关,并与多层螺旋CT(MSCT)和病理检查判断的淋巴结转移密切相关(P<0.05,P<0.01);但与年龄、性别、肿瘤位置、Lauren分类和血管浸润无关。在回顾性研究中,CCR7表达对胃癌淋巴结转移判断的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)和准确率分别为83.1%、73.8%、78.7%、78.9%和78.8%;在前瞻性研究中,CCR7表达对胃癌淋巴结转移判断的敏感性、特异性、PPV、NPV和准确率分别达85.0%、60.0%、80.9%、66.7%和76.7%。结论CCR7表达与胃癌淋巴结转移密切相关,对内镜活检组织检测CCR7的表达有助于预测胃癌淋巴结转移及决定淋巴结清扫的手术范围。CCR7可能成为胃癌治疗的新靶点。     

人类表皮生长因子受体2表达与胃癌组织学的相关性研究

目的 分析内镜下不同活检部位胃癌组织中人类表皮生长因子受体2（HER2）表达阳性率及与胃癌组织学特点相关性。方法 收集本院2017年1月至2020年1月收治的胃癌患者87例列入胃癌组,选取同期住院治疗的慢性浅表型胃炎患者21例列入正常胃黏膜组,入院后将内镜或手术获得的标本行病理检查,比较内镜标本中不同活检部位组织的HER2阳性率和胃癌病理学特征与人类表皮生长因子受体2表达水平的关系。结果 胃癌组HER2阳性率较胃黏膜正常组更高（17.2%和0.0%,P<0.05）,内镜下肿瘤浅表弥漫部、溃疡隆起部、溃疡床及肿块突起部组织HER2阳性率分别是100%、90%、44%、100%,病理类型为管状腺癌及镜下不含印戒细胞较其他组织类型癌和镜下含印戒细胞HER2阳性率高（分别是23.0%、23.6%和3.8%、6.3%,P<0.05）。结论 胃癌HER2表达水平与其病理组织学特点具有相关性,镜下不含印戒细胞的胃癌组织HER2阳性率可能更高,在评估内镜活检标本HER2表达时应着重选择肿瘤浅表弥漫部和肿块突起部,可以为胃癌靶向治疗提供参考。     

内镜超声检查和多层螺旋CT对胃癌术前T、N分期的比较研究

目的探讨内镜超声(endoscopicultrasonography,EUS)与多层螺旋CT(multi slicespiralCT,MSCT)在胃癌术前T、N分期中的临床应用价值。方法2000年10月至2002年5月,对89例活检证实的胃癌病人术前分别行内镜超声和多层螺旋CT检查,并与手术病理结果对照。结果EUS对胃癌术前T分期的准确率为75.6%,其中T176.5%,T268.8%,T384.4%,T464.7%;MSCT分别79.3%,58.8%,62.5%,90.6%和94.1%。两者差异无统计学意义(P>0.05)。EUS对胃癌术前N分期的准确率为57.5%,其中N095.8%,N145.8%,N232.0%;MSCT分别78.1%,70.8%,75.0%和88.0%。EUS和MSCT对胃癌淋巴结转移的敏感性分别为61.2%和91.8%。EUS对N0分期的准确率显著高于MSCT(P<0.05),MSCT对N和N2分期的准确率及淋巴结转移的敏感性均显著高于EUS(P<0.05,P<0.01,P<0.01)。结论内镜超声检查与多层螺旋CT对胃癌术前TN分期均有较高的准确性。     

Differences between Biopsy- or Specimen-related Laurén andWorld Health Organization Classification in Gastric Cancer

The extent of stomach resection in gastric cancer depends on tumor size, tumor location, depth of invasion, and the histological allocation to intestinal or diffuse type according to Laurén. As the latter is based on preoperative findings we performed a retrospective histomorphological study to quantify the differences between biopsy-related and surgical specimen-related Laurén classification. Additionally the World Health Organization (WHO) classification of preoperative endoscopic biopsies and surgical specimens were compared. Preoperative biopsies and resected tumor specimens from 100 patients with primary gastric carcinoma were retrospectively classified according toLaurén and WHO. The reclassification was independently performed by three pathologists who were not aware of the previous diagnoses. In 74% the Laurén classification of pre- and postoperative specimens was identical, whereas 26% of the cases showed a disagreement. Out of 48 tumors with preoperative diagnosis of an intestinal type, 10 tumors (20.8%) exhibited a diffuse growth pattern in the gastrectomy specimens; and 16% of the cases showed a disagreement of the pre- and postoperative histopathological type according to the WHO classification. Preoperative biopsy-related and surgical specimen-related Laurén classification differ in about one-quarter of the cases. Mostly, the preoperative diagnosis of an intestinal tumor type must be corrected into a diffuse or mixed type according to Laurén. Since this may have consequences for the surgical strategy, the extent of surgical resection, rebiopsies, and reconfirmation of an intestinal type should be performed at least in those cases with any doubts of this classification.     

Diagnosis of gastric cancer on endobiopsies using the WHO classification

Gastric cancer (GC), one of the most frequent malignancies can be early detected on endobiopsies. Our aim was to evaluate histologically the GC on endobiopsies, using WHO 2000 and Lauren classifications. The study included 2424 gastric endobiopsies, routine processed; sections stained with HE, Giemsa, PAS and AB. GC was diagnosed in 451 cases (19%), mostly in men (311 cases--69%). The highest incidence was in 60-69 year-old aged patients (34%). Using Lauren classification, 279 cases were included in diffuse type (62%), 167 intestinal-type (37%) and 5 (1%) mixed type. Each of these three types were also histologically analyzed considering the WHO classification. We pointed out that GC can be diagnosed histologically on endobiopsy specimens, although it is difficult to diagnose the GC--mixt type, due to reduced size of endobiopsies. Lauren classification (including the two major types: diffuse and intestinal) is very useful, especially if correlated with histological criteria of WHO classification.     

Hyperplastic polyps of the stomach: associations with histologic patterns of gastritis and gastric atrophy

Hyperplastic polyps are common gastric lesions characterized by hyperplastic foveolae with variable amounts of inflamed stroma. Their pathogenesis is unknown, but they have been reported to occur in association with various forms of chronic gastritis, particularly autoimmune gastritis and Helicobacter pylori gastritis. Comprehensive histologic evaluation of the background mucosal pathology in patients with hyperplastic polyps has not been previously performed. We studied 160 patients with gastric hyperplastic polyps and characterized endoscopic and histologic features of the polyps (i.e., location, multiplicity, and presence of dysplasia and adenocarcinoma) and the background gastric mucosa (i.e., intestinal metaplasia, dysplasia, carcinoma, and presence and classification of gastritis). Hyperplastic polyps were most common in the antrum (60%) and were multiple in 20% of patients. Focal intestinal metaplasia of the polyp was present in 16% and dysplasia in 4% of patients. Only one patient (0.6%) had adenocarcinoma within the polyp. Evaluation of the surrounding gastric mucosa showed at least focal intestinal metaplasia in 37% of patients, adenoma or low-grade flat epithelial dysplasia in 2%, and synchronous or metachronous adenocarcinoma in 6%. Eighty-five percent of patients had inflammatory mucosal pathology, most commonly active chronic H. pylori gastritis (25%), reactive or chemical gastropathy (21%), and metaplastic atrophic gastritis of the autoimmune (12%) or environmental (8%) type. These results indicate a strong association between various forms of gastritis and the development of hyperplastic polyps and further emphasize the importance of biopsy of the nonpolypoid gastric mucosa during endoscopic examination.     

Gastric carcinoma in young adults

Of 720 patients with gastric carcinoma treated over a 6-year period, 37 (5%) were 35 years of age or younger. They differed from older patients in that the usual sex ratio was altered (18 men: 19 women), and in certain histologic features. Poorly differentiated or undifferentiated lesions predominated (34 patients), and the distribution of histologic types was unusual; two thirds each were of the diffuse type (Lauren classification) or signet ring type (World Health Organization classification), and over three quarters were infiltrative (Ming classification). Intestinal metaplasia was absent in the majority of patients, and gastritis was less commonly seen than in older patients. Although most patients had long histories of disease and advanced disease, the TNM stages and the proportion undergoing curative resection (8%) were similar to those seen in older patients. Except for one who has survived 5 years, all patients in this study have died.     

Helicobacter pylori and gastric cancer. The incidence of infection in personal experience

BACKGROUND: Helicobacter pylori is an identified carcinogen for gastric cancer, but the underlying mechanisms remain to be defined. The aim of this study is to analyze the incidence of Hp infection in our series of patients with gastric carcinoma. METHODS: Between 1988 and 1998, 60 patients with diagnosis of gastric adenocarcinoma underwent partial or total gastrectomy. Forty-one were males and 19 females with an average age of 62 years (range 36-79). Twenty-seven cancers (45%) were localized in the lower third of the stomach, 17 (28%) in the middle third and eight (13%) in the upper third or cardias. In six patients (10%) the tumor was multicentric, while a recurrence on gastric stump after subtotal gastrectomy was present in two cases (3%). According to Lauren's criteria 39 cancers (65%) were of intestinal type, 16 (27%) of diffuse type and five (8%) of mixed type. The histologic preparations have been re-examined in order to verify the presence or not of Hp on gastric mucosa around neoplasm. RESULTS: Hp was found in 35 (58%) of the analyzed specimens and therefore a significant percentage of patients was Hp-positive at the time of diagnosis and surgery. Between 35 Hp-positive samples, 24 were adenocarcinomas of intestinal type, nine of diffuse type and two of mixed type, with a prevalence of Hp in intestinal type cancer. CONCLUSIONS: This study confirmed the high incidence of Hp infection in patients with gastric carcinoma, particularly in those with intestinal type cancer.     

结直肠上皮内瘤变和癌的新概念与临床应用

目的介绍WHO（2000年）对结直肠上皮内瘤变和癌的活检诊断标准,旨在避免过度或过低诊断。方法根据WHO（2000年）对结直肠上皮内瘤变和癌的活检诊断标准,对2001年1月至2005年10月间,56例手术标本诊断为癌和上皮内瘤变的病理切片及同一患者术前活检切片进行对照研究。结果56例患者中术前活检诊断原位癌、黏膜内癌、腺瘤癌变16例,根据新标准有14例应更正为高级别上皮内瘤变。结论根据WHO（2000年）对结直肠上皮内瘤变和癌的活检诊断标准,可避免过度诊断;但对活检见不到黏膜肌的病例须紧密结合临床各项检查进行综合诊断,以免造成过低诊断导致贻误治疗。     

青年人胃癌

目的 探讨40岁以下青年人胃癌的临床病理特征。方法 回顾性分析了10年间收治的304例41岁以下青年人胃癌病例,结果 40岁以下病例占同期全部病例的4.9%,其中36岁以下患占2.4%,病理分类中以弥漫型癌多见,占196例,肠型胃癌98例;肿瘤的TNM分期中Ⅳ期病例占53.95%,进展期病变占全部的83.2%;手术切除率为73.9%,根治手术率为56.0%,全组5、10年总生存率分别为28.7%和24.9%,多因素回归分析表明远处转移,肿瘤病理分期以及肿瘤的根治度是影响预手的独立因素,结论 青年人病例类型以弥漫型癌占多数,进展期病变占绝大多数,手术切除率较低,年龄不是影响预后的独立因素。但是30岁以下患预后不良。     

Management of gastric remnant carcinoma based on the results of a 15-year endoscopic screening program.

SUMMARY BACKGROUND DATA: Partial gastrectomy for benign peptic ulcer disease is associated with an increased risk of adenocarcinoma of the gastric remnant, especially in patients who are at least 15 years' postgastrectomy. Increasing evidence of mucosal dysplasia is noted on random gastric biopsy and may serve as a histologic marker in the identification of early cancer of the gastric stump. METHODS: From an initial group of 233 patients who underwent gastrectomy for benign peptic ulcer disease between 1960 and 1975, 163 patients began yearly flexible gastroscopy and random mucosal biopsy. Routine histologic studies identified either normal or dysplastic epithelium as well as adenocarcinoma. An average of eight biopsies were taken per endoscopic study. All endoscopic studies were performed by surgical residents under the supervision of one surgical attending. RESULTS: From July 1980 to June 1995, 145 patients completed annual gastroscopy and random biopsy. A total of 2287 endoscopic studies were performed. Fifteen patients were found to have severe dysplasia. Nine (60%) had associated microscopic evidence of adenocarcinoma. Four additional patients had macroscopic adenocarcinoma on endoscopic examination. All 13 patients with cancer were asymptomatic. Six patients continue surveillance who display moderate-to-severe dysplasia alone. The 13 patients with carcinoma underwent completion gastrectomy (R2 nodal dissection) with no evidence of cancer found beyond the gastric wall. These patients averaged 29 years since their original partial gastrectomy. OBJECTIVE: A prospective screening program for gastric remnant cancer was begun to assess the ability to discover early neoplastic changes on random biopsy and to make treatment decisions regarding the efficacy of completion gastrectomy after discovery of carcinoma. CONCLUSIONS: Aggressive annual screening using flexible endoscopy and multiple random biopsy may discover cancer in the gastric remnant and can lead to completion curative gastrectomy in asymptomatic people. Patients who are at least 20 years postpartial gastrectomy for benign disease should be considered for annual endoscopic surveillance.