胃底腺型胃癌2例临床病理观察

目的探讨胃底腺型胃癌(gastric adenocarcinoma of fundic gland type, GA-FG)的临床病理学特征、诊断及鉴别诊断。方法 分析2例GA-FG的内镜、组织形态学和免疫表型特征。结果 2例患者分别为46岁女性和77岁男性,均伴有胃部胀满、嗳气,胃底腺息肉病史。内镜特征:2例均为表浅隆起型病变(0~Ⅱa),病变处黏膜颜色正常伴表面小血管充血,边界可见。镜下病变表面被覆无异型的胃小凹上皮,固有层腺体轻度异型增生,排列紊乱融合,由2种细胞构成:一种类似胃底腺主细胞,另一种类似壁细胞,以前者为主。病灶最大径分别为5 mm及2.5 mm,浸润黏膜下层(浸润深度分别为0.5 mm及0.4 mm),无间质反应及脉管侵犯。周围胃黏膜未见萎缩等异常,未查见幽门螺旋杆菌。免疫表型:异型腺体MUC6、pepsinogen-I弥漫(+),H +/K +-ATPase、p53散在(+),Ki-67增殖指数5%~10%,β-catenin胞膜/质(+)。结论 GA-FG是一种新的组织学类型胃癌,具有独特的临床病理特征,预后良好,但需要长期随访。

Clinicopathological analysis of gastric adenocarcinoma of fundic gland type

Purpose To investigate the clinicopathological features of gastric adenocarcinoma of fundic gland type (GA-FG) and its diagnosis and differential diagnosis. Methods The features of endoscopy, morphology and immunophenotype were reviewed in 2 cases of GA-FG retrospectively. Results One patient was a 46 years old female, the other was a 77 years old male. Both had symptoms as gastric fullness and belching, and had history of fundic gland polyp. Endoscopically, 2 cases all showed superficial elevated type (0~Ⅱa) lesions. The lesions had normal mucosal color and sharp border, with small blood vessels dilated on the surface. Morphologically, there were mildly dysplasia but fused glands in lamina propria covered by normal gastric foveolar epithelium. The glands composed of two kinds of cells which resembled chief cell and parietal cell of fundic gland, chief cell prominently. The maximum diameter of the lesion was 5 mm and 2.5 mm, and the lesion invaded submucosa (the depths were 0.5 mm and 0.4 mm, respectively), without interstitial reactions and vessel invasion. There was no atrophy of surrounding gastric mucosa, and the Helicobacter pylori were negative. Immunohistochemistry, dysplastic glands expressed MUC6 (diffusely +), pepsinogen-Ⅰ(diffusely +), H +/K +-ATPase (dispersedly+), p53 (dispersedly +), Ki-67 (5%~10%+),β-catenin (membrane/plasma +). Conclusions GA-FG is a new histological type of gastric carcinoma, has unique clinicopathological features and good prognosis, but long-term follow-up are recommended.