桂西少数民族地区332例胃癌内镜病理分析

目的：探讨胃癌的内镜及病理特点。方法：回顾性分析本院经胃镜检查并经病理确诊的胃癌患者临床资料。结果：胃癌检出率为1.4％（332/23545），男女之比为2.8：1。BorrmannⅢ型胃癌最常见，发病部位以胃窦为主，占46.7％。组织学类型以高分化腺癌占大多数。病理特点在各年龄组及不同性别之间有明显差异（P＜0.05）。结论：本地区胃癌以中老年为主，年龄、性别与胃癌的内镜分型、组织学类型及癌细胞分化程度有关，对不同类型的病人应根据其内镜及病理特点提高胃癌的检出率。     

类似早期胃癌的进展期癌——附14例分析报道

1981年以来,经手术及病理确诊类似早期胃癌的进展期癌14例,占同期手术切除胃癌的6.2％。发病部位以贲门部最多,占57.1％,内镜检查凹陷型(Ⅱ_c、Ⅲ Ⅱ_c)5例(35.7％),隆起型(Ⅰ、Ⅱ_a)7例(50％),12例疑诊早期胃癌,2例诊断为慢性胃炎。病理组织学特点以低分化型腺癌最多,占64.3％,11例浸润至肌层,仅3例超过肌层,淋巴结转移亦较少。本病介于早期与进展期之间,预后较好。经随访2～8年,11例存活,3例死亡。     

类似早期胃癌的进展期癌——附14例分析报道

1981年以来,经手术及病理确诊类似早期胃癌的进展期癌14例,占同期手术切除胃癌的6.2％。发病部位以贲门部最多,占57.1％,内镜检查凹陷型(Ⅱ_c、Ⅲ+Ⅱ_c)5例(35.7％),隆起型(Ⅰ、Ⅱ_a)7例(50％),12例疑诊早期胃癌,2例诊断为慢性胃炎。病理组织学特点以低分化型腺癌最多,占64.3％,11例浸润至肌层,仅3例超过肌层,淋巴结转移亦较少。本病介于早期与进展期之间,预后较好。经随访2～8年,11例存活,3例死亡。     

结外淋巴瘤79例误诊分析

目的:探讨79例结外淋巴瘤的发病情况、误诊原因及防范对策。方法:对79例结外淋巴瘤的临床资料进行回顾性分析。结果:79例(包括胃肠道、鼻咽、中枢神经系统、腮腺等部位)患者常误诊为相应部位的炎症或其他肿瘤。本病误诊率为87.3%,误诊原因为①临床少见,临床医生注意不够。②临床表现缺乏特异性。③专科医师知识面窄,满足于本专业疾病的诊断。④病理科医师对本病的认识不够,未进行必要的免疫组化检查。⑤内镜检查及影像学检查无特异性。⑥取材不佳。结论:提高对本病的认识、详细询问病史及体格检查、对于低分化或未分化癌以及鼻咽部肿物常规行免疫组化检查、加强临床与病理科医师的沟通、正确的取材等有助于减少误诊的发生。     

结外淋巴瘤79例误诊分析

目的:探讨79例结外淋巴瘤的发病情况、误诊原因及防范对策.方法:对79例结外淋巴瘤的临床资料进行回顾性分析.结果:79例(包括胃肠道、鼻咽、中枢神经系统、腮腺等部位)患者常误诊为相应部位的炎症或其他肿瘤.本病误诊率为87.3%,误诊原因为①临床少见,临床医生注意不够.②临床表现缺乏特异性.③专科医师知识面窄,满足于本专业疾病的诊断.④病理科医师对本病的认识不够,未进行必要的免疫组化检查.⑤内镜检查及影像学检查无特异性.⑥取材不佳.结论:提高对本病的认识、详细询问病史及体格检查、对于低分化或未分化癌以及鼻咽部肿物常规行免疫组化检查、加强临床与病理科医师的沟通、正确的取材等有助于减少误诊的发生.     

青年人胃癌临床、内镜特点及误诊原因分析

目的 探讨青年人胃癌的临床、内镜特点及误诊原因.方法 选择经临床及病理确诊的胃癌病人96例.按年龄分组:21例(≤40岁)胃癌患者为青年组、75例(≥60岁)胃癌患者为老年组.比较两组的临床症状、病程、内镜下Borrmann分型、病变部位、病理类型、手术结果及预后.结果 青年组胃癌女性多发,男女之比1:2;老年组男性多发.男女之比2.8:1;腹痛腹胀为其主要的消化道症状.青年人无特异性的临床表现,而老年组症状较突出(P<0.05);老年组贫血例数明显高于青年组(P<0.05).病程:青年组病程≤3个月者明显高于老年组(P<0.05).内镜下胃癌分型:青年组以BⅢ型、Ⅳ型为主.老年组多为BorrmannI Ⅰ型、Ⅱ型(P<0.05);青年组胃癌以胃窦为主,老年组以胃高位癌多见(P<0.05);病理组织学显示青年组以低分化癌及印戒细胞癌为主,老年组以高分化居多(P<0.05).随访结果:一年生存率青年组明显低于老年组.结论 青年人胃癌较老年人胃癌相比,其恶性程度高、分化程度低、病程进展快、预后差.临床表现无特异性易误诊.临床医生应提高对青年人胃癌的认识及警惕性.     

青年人胃癌100例临床X线分析

 本文报告100例青年人胃癌,占同期确诊胃癌的2.09%,84例经上消化道钡餐检查诊断,25例经胃镜检查确定。93例经病理证实,88例经手术证实。青年人胃癌合并症多,转移率高而治疗率较低,25岁以下女性发病率较高,并可合并妊娠及闭经。本组病例病理组织学特征以腺癌为多,部位以胃窦部及胃小弯为主。X线征象与成年人相比无明显不同。主要误诊原因是对青年人胃癌缺乏警惕性。     

Reprimo与P16甲基化在胃癌诊断中的价值及其临床意义

目的 探讨胃癌组织中Reprimo与P16基因启动子甲基化在胃癌诊断中的价值及其临床意义.方法 选取68例确诊胃癌患者、50例慢性萎缩性胃炎伴肠上皮化生患者,所有患者均采用内镜取胃黏膜组织进行甲基化检测,对比两组Reprimo与P16基因启动子甲基化阳性率,并探讨其与患者临床病理特征的关系.结果 胃癌组胃黏膜组织标本中Reprimo基因启动子甲基化阳性率为64.71％,明显高于胃炎组的26.00％(P﹤0.01);胃癌组胃黏膜组织标本中P16基因启动子甲基化阳性率为42.65％,高于胃炎组的24.00％(P﹤0.05);胃癌组中发生淋巴结转移、TNM分期为Ⅲ期及Ⅳ期、低分化患者胃黏膜组织标本中Reprimo基因启动子甲基化率高于未发生淋巴结转移、TNM为Ⅰ期及Ⅱ期、高分化和中分化患者(P﹤0.05);不同年龄、性别、癌胚抗原(CEA)水平、肿瘤部位、TNM分期、淋巴结转移情况、分化程度、肿瘤直径的胃癌患者胃癌组织中P16基因启动子甲基化率比较,差异均无统计学意义(P﹥0.05).结论 胃癌组织中Reprimo基因启动子甲基化率明显升高,并且与胃癌的发生发展有关;P16基因启动子甲基化在胃癌组织中甲基化阳性率与胃炎组织相比较,无明显增加.     

40例青年人胃癌临床病理及预后

本文报告40例≤35岁青年人胃癌,其中≤30岁26例,最小年龄21岁,占同期胃癌3.79％。与对照组(≥50岁胃癌组)相比有明显不同点:女性多见,男:女为1:1.9;遗传倾向明显,胃癌家属史阳性(8例,20％)与对照组相比有非常显著性差异,与血型A关系较密切;组织学类型以未分化癌或弥漫性胃癌占优势;预后差,一年内死亡19例,五年生存率5.6％。     

消化道内镜活检病理诊断食管癌、胃癌临床病理分析

目的:探讨食管癌及胃癌临床及病理特征。方法:对我院1998年～2002年间经消化内镜取活检,并经病理切片确诊的食管癌672例、胃癌520例临床病理资料进行回顾性分析。结果:食管癌以进行性咽下困难、咽下疼痛、食物返流为主,肿瘤大体形态以髓质型为主,发生部位以食管中段多见,病理组织学形态以低分化、中分化鳞癌多见。胃癌则以上腹痛、食欲减退、消瘦、贫血、黑便为其主要的症状。青年组(<40岁)以上腹痛及黑便为主.病程短,胃底及贲门部多发,大体分型多为Borrmann Ⅲ型、Ⅳ型.病理组织学显示以低分化腺癌、印戒细胞癌、未分化癌为主;其他年龄组(>40岁)临床症状以上腹饱胀不适、食欲减退、消瘦、贫血为主,病程长,幽门部多发,大体分型多为Borrmann I型、Ⅱ型,病理组织学显示多为乳头状腺癌、管状腺癌。结论:食管癌患者以食管中段多发为主,并以低分化鳞癌多见。青年组胃癌与其他年龄组胃癌相比较,其浸润能力强,恶性程度高,分化程度低,病情进展快,预后差。临床医师应该认识到消化道内镜活检是提高食管癌、胃癌确诊率的重要手段。     

Improvements in diagnosis have changed the incidence of histological types in advanced gastric cancer.

The data on 912 patients with early cancer and 1245 with advanced cancer who were seen between 1971 and 1990 were compared. The incidence of undifferentiated-type cancer increased significantly in patients with advanced gastric cancer, but not in patients with early gastric cancer. When the histological types were compared with regard to sex, age and location in patients with early gastric cancer the undifferentiated type was found to increase only in males, while in patients with advanced gastric cancer the undifferentiated type increased in both sexes as well as in younger patients and in both the upper and middle third of the stomach. These differences in the trends between early and advanced cancers are probably due to the different degrees of diagnostic accuracy for the early detection of histological types.     

Diffuse bone metastasis with hematologic disorders from gastric cancer: clinicopathological features and prognosis

Bone metastases diffusely invading the bone marrow from gastric cancer often manifest a rapid clinical course and the prognosis is very poor due to hematologic disorders such as DIC (disseminated intravascular coagulation) and/or MAHA (microangiopathic hemolytic anemia). The objective of this study was to clarify the clinicopathological features and prognosis of patients with gastric cancer in whom diffuse bone metastasis associated with hematologic disorders were evident. Thirty-eight patients with bone metastasis from a primary gastric cancer were thus selected and placed into 2 groups consisting of 15 with diffuse bone metastasis with DIC and/or MAHA, and 23 patients who had bone metastasis without hematological disorders. We compared the clinicopathological features and prognosis between the two groups. The clinicopathological features in patients with diffuse bone metastasis accompanied by hematologic disorders were significantly related to undifferentiated adenocarcinoma, a relatively younger age, elevated levels of serum ALP-BI and LDH, and a lower frequency of extraosseous metastasis. The median survival time after manifestation was 2 and 11 months for the patients with or without hematologic disorders, respectively. The prognosis was significantly worse in cases of DIC with the median survival being only one month. Since, prognosis of diffuse bone metastasis from gastric cancer is significantly poor, close attention should be directed to the specific clinicopathologic features related to diffuse bone metastasis plus hematologic disorders. Regarding high risk patients, a regular follow-up of the serum chemistry levels and a bone scan will aid in the early detection of the disease.     

Therapeutic strategy for patients with pN0 gastric carcinoma

BACKGROUND AND OBJECTIVES: The prognosis for patients with pN0 gastric cancer is moderately hopeful (expected 5-year survival: 80%). However, the relevant prognostic factors and most appropriate surveillance protocol have not been identified. METHODS: We investigated 733 gastric cancer patients without lymph node metastasis for prognostic factors by uni- and multi-variate analysis and by documenting causes of death and recurrence patterns. RESULTS: Univariate analysis revealed that age, tumor location, macroscopic appearance, tumor diameter, invasion depth, lymphatic invasion, and venous invasion affected prognosis. Multivariate analysis showed that age (> or = 60 years), ill-defined macroscopic appearance, and undifferentiated histological type independently reduced survival rates. Age (> or = 60 years) and undifferentiated histological type adversely influenced prognosis in 507 early gastric cancer patients whereas ill-defined macroscopic appearance adversely affected prognosis in 226 advanced cancer patients. Recurrence patterns in these patients were similar to those produced by lymph node metastasis. The predominant recurrence pattern was peritoneal dissemination, observed 2-3 years post-resection. CONCLUSIONS: This study identified adverse prognostic factors in pN0 gastric cancer patients. Randomized controlled studies of adjuvant chemotherapy are necessary to assess whether such therapy is beneficial for patients with adverse prognostic factors.     

纤维内镜活检胃黏膜诊断胃癌的临床病理分析

目的：探讨纤维内镜活检查出胃癌的检出率及胃黏膜活检病理诊断中存在的问题。方法：对我科近三年胃黏膜活检1669例标本中诊断为胃癌的病理诊断结果进行回顾性分析。结果：诊断胃癌病例为148例,检出率为8．9％,年龄16—86岁,其中8例因需鉴别诊断、肿瘤组织量少等原因初诊为高级别异型增生可疑癌变或高级别异型增生,后经再次取材或胃切除手术后诊断为胃癌;2例初诊漏诊,后经复片后诊断为胃癌;所有胃黏膜活检病理诊断结果中有1例初诊为未分化胃癌,后行胃切除手术后修正诊断为恶性淋巴瘤。结论：纤维内镜对胃癌的检出具有重要价值,是一种非常有效的检查方法;胃黏膜活检病理诊断虽常见,但实际诊断中仍存在不少问题。     

Tumor differentiation is not a risk factor for lymph node metastasis in elderly patients with early gastric cancer

BackgroundThe aim of this study was to identify risk factors for lymph node metastasis in elderly patients (70 years or more) with early gastric cancer.MethodsWe reviewed the prospectively collected database of 6893 patients with early gastric cancer who had undergone curative gastrectomy in 3 tertiary cancer centers between January 2003 and December 2009 in Korea. Patients were sorted into 4 groups according to age: less than 50, fifties, sixties, and 70 years or more. Risk factors for lymph node metastasis in early gastric cancer were analyzed.ResultsOne thousand and thirty five patients (15.0%) were 70 years or more. As age increased, the frequency of large differentiated tumor, lymphatic and submucosa invasion increased. Old age was associated with a lower risk for lymph node metastasis in patients with early gastric cancer (Odds ratio [OR], OR, 0.622; 95% CI, 0.5466–0.830, P = 0.010). Ulceration or differentiation of tumor was not associated with lymph node metastasis in elderly patients with early gastric cancer.ConclusionsElderly patients with undifferentiated type histology early gastric cancer without other risk factors for lymph node metastasis may be candidates for endoscopic resection.     

Efficacy of weekly administration of paclitaxel for advanced or recurrent gastric cancer with peritoneal dissemination

We report 3 gastric cancer patients with peritoneal dissemination who failed to take TS-1 due to adverse effects and who were successfully treated with weekly paclitaxel administered intravenously. The patients were 2 men and 1 woman from 73 to 82 years in age. The histological types of gastric cancer were undifferentiated adenocarcinoma in all cases. Intravenous infusion of TXL (62-80 mg/m2) after short premedication was continued for 3 weeks followed by 1 week rest. Clinical symptoms, including ascites and intestinal obstruction, improved only after administration of 1 cycle in all patients. Except for 1 event with grade 3 neutropenia, no major adverse reactions were observed. Weekly administration of paclitaxel may be a promising chemotherapy for controlling peritoneal metastasis and improving the quality of life of patients with advanced or recurrent gastric cancer.     

Risk of Lymph Node Metastases from Early Gastric Cancer in Relation to Depth of Invasion: Experience in a Single Institution

Background: An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of early gastric cancers. Therefore, this study analyzed predictive factors associated with lymph node metastasis and identified differences between mucosal and submucosal gastric cancers. Materials and Methods: A total of 518 early gastric cancer patients who underwent radical gastrectomy were reviewed in this study. Clinicopathological features were analyzed to identify predictive factors for lymph node metastasis. Results: The rate of lymph node metastasis in early gastric cancer was 15.3% overall, 3.3% for mucosal cancer, and 23.5% for submucosal cancer. Using univariate analysis, risk factors for lymph node metastasis were identified as tumor location, tumor size, depth of tumor invasion, histological type and lymphovascular invasion. Multivariate analysis revealed that tumor size >2 cm, submucosal invasion, undifferentiated tumors and lymphovascular invasion were independent risk factors for lymph node metastasis. When the carcinomas were confined to the mucosal layer, tumor size showed a significant correlation with lymph node metastasis. On the other hand, histological type and lymphovascular invasion were associated with lymph node metastasis in submucosal carcinomas. Conclusions: Tumor size >2 cm, submucosal tumor, undifferentiated tumor and lymphovascular invasion are predictive factors for lymph node metastasis in early gastric cancer. Risk factors are quite different depending on depth of tumor invasion. Endoscopic treatment might be possible in highly selective cases.     

Precancerous changes and the histogenesis of stomach cancer

142 cases of gastric cancer, 20 cases of chronic ulcer, 800 gastrobiopsies, performed for chronic gastritis, were studied morphologically. Adenocarcinoma and undifferentiated gastric cancer were found to have different precancerous lesions in the background. It was shown that among undifferentiated cancers the signs of chronic ulcer preceding cancer are noted more frequently than among adenocarcinomas. Grave forms of atrophic gastritis and gastritis of the mucous membrane regeneration beyond the tumor were revealed more frequently in adenocarcinomas than in undifferentiated cancers. These precancerous affections were found to be associated with the proliferation of different cell elements of gastric mucous membrane, that conditions various listogenesis of basic histological forms of cancer of the stomach. The proliferation of the lining-gastric pit epithelium, mainly observed in gastritis, results in the appearance of adenocarcinomas. The proliferation of the glandular epithelium, particularly that of glandular ducts in ulcerous disease would condition the development of undifferentiated forms of gastric cancer.     

Helicobacter pylori, atrophic fundal gastritis and risk for gastric adenocarcinoma

Fundal atrophic gastritis and Helicobacter pylori have been implicated as possible etiologic factors in gastric cancer. This case-control study was performed to determine which risk factor is more closely related to gastric cancer. The endoscopic Congo red test was performed to evaluate the extent of fundal atrophic gastritis in 43 patients with gastric cancer and 86 cancer-free control subjects, who were individually matched by age, sex, and date of endoscopy (within 3 months). The prevalance of H. pylori infection and severe fundal gastritis were significantly higher in patients with differentiated adenocarcinoma, but not with undifferentiated adenocarcinoma, than in control subjects. The odds ratios for differentiated and undifferentiated adenocarcinomas were 6.85 (95% confidence interval, 1.94-11.82) and 1.50 (95% CI, 0.84-3.11), respectively. However, the odds ratio of H. pylori infection was greater than that of severe fundal gastritis. Moreover, multivariate analysis provided similar results. H. pylori infection is an independent indicator of a higher risk of the differentiated adenocarcinomas of the stomach than is severe fundal gastritis.     

Relationship Between Plasminogen Activators and Stomach Carcinoma Stage

The antigen levels of plasminogen activators (PAs), tissue-type PA (t-PA) and urokinase-type PA (u-PA), were measured in extracts from 30 gastric carcinomas and corresponding normal gastric mucosa. The t-PA level was significantly higher in normal mucosa than in cancer tissue, while the u-PA level was significantly higher in cancer tissue. The u-PA level increased with increasing tumor stage, and there was a significant difference between early and advanced cancer. The u-PA level also increased with the degree of nodal involvement, and it was higher in undifferentiated tumors than in well-differentiated ones. It was higher in cases with venous invasion, liver metastasis or peritoneal dissemination than in cases without these features.