胃底腺型肿瘤的内镜及临床病理学特征分析

doi:10.3877/cma.j.issn.2095-7157.2025.02.008

目的

探讨胃底腺型肿瘤的内镜、临床病理学特征、治疗及预后。

方法

回顾性分析2021 年1 月至2024 年8 月经解放军总医院第一医学中心病理科诊断为胃部胃底腺型肿瘤的17 例患者,收集患者临床信息、内镜检查及病理检查资料,并结合文献进行分析。

结果

17 例胃底腺型肿瘤中,12 例泌酸腺腺瘤(OGA)、3 例胃底腺型腺癌(GA-FG)、2 例胃底腺黏膜型腺癌(GA-FGM)。其中,男12 例、女5 例,中位年龄58 岁。内镜下,肿瘤表现为0-Ⅰ型(6 例)、0-Ⅱa 型(7 例)、0-Ⅱb 型(2 例)、0-Ⅱa+Ⅱc 型(2 例)。组织学上,肿瘤具有胃底腺分化特点,结构异型性明显,腺体密集,形状不规则,部分融合;细胞异型性小,以主细胞分化为主。免疫组化染色示胃底腺型肿瘤表达胃蛋白酶原-1、MUC6;OGA 和GA-FG 为MUC5AC 阴性,Ki-67 增殖指数较低,而GA-FGM 不同程度表达MUC5AC,Ki-67 增殖指数较高。

结论

胃底腺型肿瘤是一组少见的同一谱系的肿瘤,具有特殊的内镜表现及临床病理特征,呈惰性至不同程度侵袭性,需在日常病理诊断中对该谱系肿瘤予以重视。

关键词: 胃底腺型肿瘤, 泌酸腺腺瘤, 胃底腺型腺癌, 胃底腺黏膜型腺癌, 内镜特征, 内镜下切除术

Objective

This study aims to investigate the endoscopic, clinicopathological features,treatment and prognosis of fundic gland type neoplasms.

Methods

A retrospective analysis was conducted on 17 patients diagnosed with fundic gland type neoplasms from January 2021 to August 2024 at the Department of Pathology, First Medical Center of the PLA General Hospital. The clinical information,endoscopic findings, pathological data were collected and analyzed in conjunction with relevant literature.

Results

Among these cases, there were 12 cases of oxyntic gland adenoma (OGA), 3 cases of gastric adenocarcinoma of the fundic gland type (GA-FG), and 2 cases of gastiric adenocarcinoma of fundic gland mucosa type (GA-FGM). There were 12 males and 5 females with a median age of 58 years. The endoscopic tumors were classified as type 0-I (6 cases),type 0-Ⅱa (7 cases),type 0-Ⅱb (2 cases),and type 0-Ⅱa+Ⅱc (2 cases). Histologically, the tumor exhibited differentiation towards gastric fundus glands with evident structural atypia including dense glands with irregular shapes and partial fusion. Small cell atypia was observed predominantly along with main cell differentiation. Immunohistochemical staining showed that fundic gland type neoplasms expressed pepsinogen 1, MUC6. OGA and GA-FG were negative for MUC5AC, Ki-67 proliferation index was low, GA-FGM expressed MUC5AC in different degrees, Ki-67 proliferation index was high.

Conclusion

Fundic gland type neoplasms are rare neoplasms originating from the same lineage that exhibit variable degrees of invasiveness but generally have an indolent course. They possess distinct endoscopic manifestations and clinicopathological features requiring due attention in the routine pathological diagnosis.

Key words: Fundic gland type neoplasms, Oxyntic gland adenoma, Gastric adenocarcinoma of the fundic gland type, Gastiric adenocarcinoma of fundic gland mucosa type, Endoscopic features, Endoscopic resection

表1 17 例胃底腺型肿瘤患者的内镜表现及临床病理学信息

序号	性别	年龄	临床表现	部位	内镜形态巴黎分型	直径（cm）	诊断	HP	萎缩	肠化	治疗
1	男	53	无特殊	胃底	0-Ⅱb	0.6	OGA	-	-	-	ESD
2	男	59	食欲欠佳,消瘦1月	胃底	0-Ⅱa	0.5	OGA	-	-	-	活检
3	女	62	无特殊	胃底	0-Ⅰs	0.3	OGA	-	-	-	活检
4	女	68	间断胸骨后不适3月	胃底	0-Ⅱa	1.5	OGA	-	-	-	ESD
5	男	60	无特殊	胃底	0-Ⅰs	0.2	OGA	-	-	+	活检
6	男	52	间断腹痛,餐后加重两年	胃底	0-Ⅱa	0.8	OGA	-	-	+	ESD
7	男	68	无特殊	胃体	0-Ⅱb	0.6	OGA	-	-	-	EMR
8	女	78	无特殊	胃体	0-Ⅰs	0.3	OGA	-	-	-	活检
9	女	58	烧心、嗳气6月	胃体	0-Ⅱa	0.6	OGA	-	-	-	根治性近端胃大部切除术
10	女	83	便血5日	胃体	0-Ⅰs	0.5	OGA	-	-	-	活检
11	男	49	无特殊	胃体	0-Ⅰsp	0.5	OGA	-	-	-	活检+胰十二指肠切除术
12	男	32	无特殊	胃底	0-Ⅰsp	0.8	OGA	-	-	-	活检
13	男	49	间断进食后胃部隐痛2年	胃底	0-Ⅱa+Ⅱc	0.4	GA-FG	-	-	-	ESD
14	男	55	间断进食困难半月	胃窦	0-Ⅱa+Ⅱc	1	GA-FG	+	-	+	ESD
15	男	70	无特殊	胃底	0-Ⅱa	0.6	GA-FG	-	-	-	ESD
16	男	40	腹部不适1月	胃体	0-Ⅱa	1	GA-FGM	-	+	-	ESD
17	男	51	进食后上腹部胀痛2月	胃体	0-Ⅱa	3	GA-FGM	-	-	-	根治性全胃切除术

表1 17 例胃底腺型肿瘤患者的内镜表现及临床病理学信息

序号	性别	年龄	临床表现	部位	内镜形态巴黎分型	直径（cm）	诊断	HP	萎缩	肠化	治疗
1	男	53	无特殊	胃底	0-Ⅱb	0.6	OGA	-	-	-	ESD
2	男	59	食欲欠佳,消瘦1月	胃底	0-Ⅱa	0.5	OGA	-	-	-	活检
3	女	62	无特殊	胃底	0-Ⅰs	0.3	OGA	-	-	-	活检
4	女	68	间断胸骨后不适3月	胃底	0-Ⅱa	1.5	OGA	-	-	-	ESD
5	男	60	无特殊	胃底	0-Ⅰs	0.2	OGA	-	-	+	活检
6	男	52	间断腹痛,餐后加重两年	胃底	0-Ⅱa	0.8	OGA	-	-	+	ESD
7	男	68	无特殊	胃体	0-Ⅱb	0.6	OGA	-	-	-	EMR
8	女	78	无特殊	胃体	0-Ⅰs	0.3	OGA	-	-	-	活检
9	女	58	烧心、嗳气6月	胃体	0-Ⅱa	0.6	OGA	-	-	-	根治性近端胃大部切除术
10	女	83	便血5日	胃体	0-Ⅰs	0.5	OGA	-	-	-	活检
11	男	49	无特殊	胃体	0-Ⅰsp	0.5	OGA	-	-	-	活检+胰十二指肠切除术
12	男	32	无特殊	胃底	0-Ⅰsp	0.8	OGA	-	-	-	活检
13	男	49	间断进食后胃部隐痛2年	胃底	0-Ⅱa+Ⅱc	0.4	GA-FG	-	-	-	ESD
14	男	55	间断进食困难半月	胃窦	0-Ⅱa+Ⅱc	1	GA-FG	+	-	+	ESD
15	男	70	无特殊	胃底	0-Ⅱa	0.6	GA-FG	-	-	-	ESD
16	男	40	腹部不适1月	胃体	0-Ⅱa	1	GA-FGM	-	+	-	ESD
17	男	51	进食后上腹部胀痛2月	胃体	0-Ⅱa	3	GA-FGM	-	-	-	根治性全胃切除术

图1 胃底腺型肿瘤的内镜下表现注:A: 白光内镜下,1 例OGA 表现为0-Ⅱa 型,色调局部发红;B: 白光内镜下,1 例GA-FG 表现为0-Ⅱa+Ⅱc 型,色调局部发红;C: 放大内镜下,1 例GA-FG 表现为肿瘤界限清晰,腺管扩张排列紊乱,局部见肿瘤微血管

图2 胃底腺型肿瘤的组织学特征注:A: OGA 显示肿瘤位于黏膜内,肿瘤表面被覆正常胃小凹上皮,腺体较为密集、不规则,有腺体分支、融合呈迷路样,间质促纤维反应不明显(HE×40);B:OGA 的细胞异型性小,以主细胞分化为主,与正常组织分界欠清(HE×100);C:GA-FG 显示瘤细胞浸润至黏膜下层(HE×40)

图3 胃底腺型肿瘤的免疫组化特征注:A:1 例GA-FG 显示胃蛋白酶原-1 阳性( ×40);B:1 例OGA 显示MUC6 阳性( ×100);C:1 例OGA 显示MUC5AC 表面正常胃小凹上皮阳性,肿瘤细胞阴性( ×100)

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Fundic gland type neoplasms: endoscopic and clinicopathological analysis of 17 cases

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Fundic gland type neoplasms: endoscopic and clinicopathological analysis of 17 cases