胃镜活检病理诊断上皮内瘤变高级别的意义

Pathological diagnosis of high-grade intraepithelial neoplasia in gastric biopsy

目的探讨胃镜活检上皮内瘤变高级别的临床病理诊断意义。方法常规HE切片观察143例胃镜活检病理诊断为上皮内瘤变高级别病例的病理形态特点,并与60例手术切除和13例重复活检后的病理诊断相对照。结果60例手术切除标本中,6例术后标本未发现有癌变组织,其余54例均病理诊断证实为腺癌,进展期和早期癌各27例;其中高分化腺癌15例,中分化腺癌24例,低分化腺癌12例,黏液腺癌3例。13例重复活检的患者中,4例诊断为高分化腺癌,8例为上皮内瘤变低级别,1例为慢性炎。6例术后未发现有癌变的活检标本均有类似肠道腺瘤样的病理改变,其中5例无黏膜肌。9例活检组织中伴有纤维间质反应的病例,术后病理诊断均为腺癌。结论胃镜活检病理诊断上皮内瘤变高级别时90%已同时伴有腺癌,胃镜活检的部位和深度对病理诊断有很大影响,纤维间质反应是胃镜活检病理诊断胃癌的重要形态学指标。

Objective To investigate the pathological diagnosis of high-grade intraepithelial neoplasia in gastric biopsy. Methods One hundred and forty-three cases diagnosed by gastric biopsy as high-grade intraepithelial neoplasia were analyzed by light microscopy, and were compared with the pathological findings of surgical specimens in 60 cases and a second biopsy in 13 cases. Results Among the sixty cases treated surgically following the gastric biopsies, no carcinoma was found in 6, while the other 54, were diagnosed as gastric adenocarcinoma, 27 in advanced stage and 27 in early stage, respectively. Fifteen cases were well-differentiated, 24, moderately-differentiated, 12 poorly-differentiated and 3 were of mucinous type. Four of the 13 cases with a second biopsy were diagnosed as well-differentiated adenocarcinoma, 8 low-grade intraepithelial neoplasia and 1 chronic inflammation. The colorectal adenomas-like changes were morphologically found in 6 surgically-treated cases without carcinoma, 5 of whom mucous muscles were not found by biopsy. Fibroblastic reactions were found in 9 cases, all of which were diagnosed as adenocarcinoma in surgical specimens. Conclusion Ninety percent of the cases who are diagnosed as high-grade intraepithelial neoplasia by biopsy may have already been complicated with adenocarcinoma. The location and depth of the specimen in gastric biopsy have a considerable influence on pathological diagnosis. The fibroblastic reaction may be considered as an important marker for gastric adenocarcinoma in pathological diagnosis of gastric biopsy.