北京大学学报(医学版) ›› 2023, Vol. 55 ›› Issue (2): 292-298. doi: 10.19723/j.issn.1671-167X.2023.02.013
Wei-hua HOU1,Shu-jie SONG2,Zhong-yue SHI3,Mu-lan JIN3,*()
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。
中图分类号:
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