胃上皮异型增生107例临床病理学观察

目的 探讨胃上皮异型增生及相关病变Padova国际分类的诊断标准及临床病理意义。方法 按照1998年Padova国际分类标准,收集复习既往胃黏膜活检诊断为各级异型增生的病例107例,对其中71例进行随访或追踪复查,38例伴有肠化者行HID／AB黏液染色。结果 既往诊断为轻度异型增生的42例中,按Padova分类标准仅9例诊断低度异型增生,27例不确定为异型增生,其余6例为异型增生。42例中,13例获随访结果,12例经一次或多次复查为浅表或萎缩性胃炎,1例进展为黏膜内癌。按Padova分类诊断不能确定为异型增生中的14例获随访结果,复查均为浅表或萎缩性炎。Padva分类将异型增生分为2级,据记随访复查资料,诊断低度异型增生的癌发现率是3／9,高度异型增生的术后癌诊断率是5／5,高度异型增生伴局部可疑浸润的术后癌诊断是10／10。结论 以往安三级分类诊断为轻度异型增生的病例,多数是慢性胃炎的反应性上皮增生,非真性肿瘤。按Padova分类,应列入“不能确定为异型增生” 组观察随诊。胃黏膜活检诊断高度异型增生的病例常合并有早期癌或浸润癌,诊断确定后应早期手术切除病灶。

Criteria and significance of Padova international classification for gastricdysplasia

Objective To explore the diagnostic criteria and clinic pathological significance of the Padova international classification for gastric dysplasia (PICGG). Methods One hundred and seven cases of gastric dysplasia with different grades were reviewed by using the criteria of PICGG, in which 71 cases were followed up and 38 cases were stained by HID/AB staining. Results Among 42 cases of mild dysplasia diagnosed in the past, 9 were classified as low-grade dysplasia, 27 as indefinite for dysplasia and 6 as negative for dysplasia by using PICGG. Follow-up data showed that 12 in 13 cases of mild dysplasia regressed and one of them progressed to intramucosal carcinoma; All the 14 cases of indefinite for dysplasia regressed to chronic gastritis; By the two-grade system of PICGG, 3 in 9 cases of low grade dysplasia progressed to carcinoma, all 5 cases of high grade dysplasia developed to carcinoma and all 10 cases of high grade dysplasia with suspicious carcinoma turned out to be invasive carcinoma, confirmed by gastrotomy specimen examination. Conclusions Most of the mild dysplasia diagnosed before are reactive epithelial hyperplasia of chronic gastritis, which should be renamed as "indefinite for dysplasia" and need to follow up. High-grade dysplasia diagnosed by endoscopic biopsies often combines with early carcinoma or invasive carcinoma, which therefore is an indication for surgical treatment.