幽门螺杆菌阴性早期胃癌的临床病理特征

doi:10.19723/j.issn.1671-167X.2023.02.013

摘要/Abstract

摘要：

目的: 探讨幽门螺杆菌(Helicobacter pylori，Hp)阴性早期胃癌的临床病理特征。方法: 回顾性收集2009—2021年解放军联勤保障部队第九八九医院平顶山医疗区和首都医科大学附属北京朝阳医院共计30例Hp阴性早期胃癌的临床资料，观察其组织形态学特征和免疫表型，并结合文献进行探讨。结果: 30例患者的中位年龄58. 5岁(范围21~80岁)，男性13例，女性17例；胃上部13例，胃中部9例，胃下部8例；肿瘤中位直径11 mm(范围1~30 mm)；按巴黎分型0-Ⅱa型9例，0-Ⅱb型7例，0-Ⅱc型14例。内镜检查18例病变发红，12例病变呈退色调或发白，均可见微血管结构和微表面结构异常；所有病例胃体及胃角黏膜可见规律排列的集合小静脉。黏膜内高分化腺癌18例，肿瘤呈腺管样及乳头状结构，腺体密集，排列紊乱；细胞呈立方形或柱状，核染色质增多，核极性丢失，多表达胃型黏蛋白。印戒细胞癌7例，癌组织全部由印戒细胞构成，癌细胞主要分布在黏膜中表层内；胃泌酸腺瘤(局限于黏膜内的胃底腺型胃癌)2例、胃底腺型胃癌2例和胃底腺黏膜型胃癌1例。肿瘤组织由轻度大小不等的分枝管状腺构成，除1例黏膜表面上皮局部是肿瘤性外，其余4例黏膜表面上皮全为非肿瘤性；细胞单层排列，核靠近基底侧，细胞核仅有轻度的不典型性。5例胃底腺肿瘤免疫组织化学染色胃蛋白酶原Ⅰ和H⁺/K⁺ATPase阳性，其中1例黏膜表面和深处的小凹型肿瘤细胞MUC5AC阳性。所有的病例癌旁胃黏膜大致正常，无萎缩、肠上皮化生和Hp。结论: Hp阴性早期胃癌是一组异质性疾病群体，组织学类型多样，常见的有管状腺癌和印戒细胞癌。管状腺癌多发生于老年人和胃中上部，印戒细胞癌多发生于中青年人和胃下部，胃底腺型肿瘤相对罕见。

关键词: 胃肿瘤, 幽门螺杆菌阴性, 临床病理学, 内镜黏膜下剥离术

Abstract:

Objective: To investigate the clinicopathological features of Helicobacter pylori (Hp)-negative early gastric cancer. Methods: The clinicopathological data of 30 cases of Hp-negative early gastric cancer were collected retrospectively at Pingdingshan Medical District, 989 Hospital of PLA Joint Logistics Support Force, and Beijing Chaoyang Hospital, Capital Medical University, from 2009 to 2021, and the histomorphological characteristics and immunophenotype were observed, and combined with the literature to explore. Results: The median age of 30 patients was 58.5 years (range: 21-80 years), including 13 males and 17 females. The upper part of the stomach was 13 cases, the middle part of the sto-mach was 9 cases, and the lower part of the stomach was 8 cases. The median diameter of the tumor was 11 mm (range: 1-30 mm). According to the Paris classification, 9 cases were 0-Ⅱa, 7 cases were 0-Ⅱb, and 14 cases were 0-Ⅱc. Endoscopic examination showed that 18 cases of lesions were red, 12 cases of lesions were faded or white, and microvascular structures and microsurface structures were abnormal. In all the cases, collecting venules were regularly arranged in the gastric body and corner mucosa. There were 18 cases of well differentiated adenocarcinoma in the mucosa. The tumor presented glandular tubular-like and papillary structure, with dense glands and disordered arrangement; the cells were cuboidal or columnar, with increased nuclear chromatin and loss of nuclear polarity, and most of them expressed gastric mucin. Signet-ring cell carcinoma was found in 7 cases, all the cancer tissues were composed of signet-ring cells, and the cancer cells were mainly distributed in the middle layer to the surface layer of mucosa. Gastric oxyntic gland adenoma (gastric adenocarcinoma of the fundic gland type confined to mucosa) in 2 cases, gastric adenocarcinoma of the fundic gland type in 2 cases, and gastric adenocarcinoma of fundic gland mucosa type in 1 case. The tumor tissue was composed of branching tubular glands, except 1 case of mucosal surface epithelium was partially neoplastic, the other 4 cases of mucosal surface epi-thelium were all non-neoplastic; the cells were arranged in a single layer, and the nucleus was close to the basal side, and the nucleus was only slightly atypical. Pepsinogen I and H⁺/K⁺ ATPase were positive in 5 cases of gastric fundus gland type tumors, and 1 case of foveolar-type tumor cells at the surface and depth of mucosa showed MUC5AC positive. The gastric mucosa adjacent to cancer was generally normal in all cases, without atrophy, intestinal metaplasia and Hp. Conclusion: Hp-negative early gastric cancer is a heterogeneous disease group with various histological types, and tubular adenocarcinoma and signet-ring cell carcinoma are common. Tubular adenocarcinoma mostly occurs in the elderly and the upper to middle part of the stomach, while signet-ring cell carcinoma mostly occurs in young and middle-aged people and the lower part of the stomach. Gastric neoplasm of the fundic gland type is relatively rare.

Key words: Stomach neoplasms, Helicobacter pylori-negative, Clinical pathology, Endoscopic submucosal dissection

中图分类号:

R735.2

侯卫华,宋书杰,石中月,金木兰. 幽门螺杆菌阴性早期胃癌的临床病理特征[J]. 北京大学学报（医学版）, 2023, 55(2): 292-298.

Wei-hua HOU,Shu-jie SONG,Zhong-yue SHI,Mu-lan JIN. Clinicopathological features of Helicobacter pylori-negative early gastric cancer[J]. Journal of Peking University (Health Sciences), 2023, 55(2): 292-298.

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参考文献 28

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Parameter	Well differentiated adenocarcinoma (n=18)	Signet ring cell carcinomas (n=7)	Gastric neoplasm of fundic gland type (n=5)
Gender
Male	8	2	3
Female	10	5	2
Age
<60 years	6	7	2
≥60 years	12	0	3
Location
Upper part	9	1	3
Middle part	7	1	1
Lower part	2	5	1
Tumor diameter
≤20 mm	13	7	5
>20 mm	5	0	0
Paris classification
0-Ⅱa	5	0	4
0-Ⅱb	4	3	0
0-Ⅱc	9	4	1
Depth of invasion
pT1a	18	7	2
pT1b	0	0	3
Phenotypes
Gastric	10	3	-
Intestinal	0	2	-
Gastrointestinal	8	2	-
Mutation expression of p53
Yes	4	0	0
No	14	7	5

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