胃黏液腺癌的临床病理和CT特征

Clinicopathological characteristics of mucinous gastric carcinoma and its CT features

目的:探讨胃黏液腺癌的临床病理和CT特征。方法:回顾性分析507例行根治或姑息性切除术的胃癌病例的临床病理资料(20例黏液腺癌和487例非黏液腺癌)及术前的多层螺旋CT检查结果;对比分析20例黏液腺癌和38例非黏液腺癌的CT征象(CT轴位图像上肿瘤最大径、厚度、大体分型及强化方式)。结果:通过术前电镜活检,仅25.0%(5/20)的胃黏液腺癌得到确诊。20例黏液腺癌均为进展期胃癌,487例非黏液腺癌中早期胃癌占16.8%(82/487),但差异无统计学意义(P=0.056)。与非黏液腺癌相比,黏液腺癌肿瘤较大[(6.9±4.0)cm比(4.4±2.3)cm,P=0.011],淋巴结转移率较高(85.0%比60.6%,P=0.028),且Ⅱ～Ⅳ期病例较多(95.0%比72.3%,P=0.025);二者在CT轴位图像上肿瘤最大径(P=0.008)、厚度(P=0.001)、大体分型(P=0.037)和强化方式(P=0.000)间均存在显著差异。但黏液与非黏液腺癌在年龄、性别、肿瘤位置、远处转移和根治性切除率间均无差异。结论:胃黏液腺癌病例数少且多属进展期,通过内镜活检判断黏液腺癌的敏感度较低,而多层螺旋CT则有助于鉴别黏液和非黏液腺癌。

Objective To investigate the clinicopathological characteristics and CT features of mucinous gastric carcinoma （MGC）. Methods Retrospectively, the clinicopathological data of 507 patients with gastric carcinoma, who underwent preoperative multi-slice spiral CT （MSCT） examination and gastrectomy were analyzed. Among these patients, 20 were found to be MGC and the other 487 were nonmucinous gastric carcinoma. The CT features （enhancement pattern, gross appearance type, maximal diameter and thickness of tumor on axial CT image） of the 20 cases of MGC and 38 patients with nonmucinous gastric carcinoma （NGC） were compared and analyzed. Results Only 5 out of the 20 cases of MGC （25.0%） was preoperatively diagnosed by endoscopic biopsy. All the 20 MGC cases belonged to advanced stages. In contrast, 16.8% （82/487） of the NGC were early gastric carcinoma cases, even though there did not exist any significant difference between the two groups （P=0.056）. The MGC patients were found to have larger tumor size [（6.9±4.0）cm vs. （4.4±2.3）cm, P=0.011], higher frequency of lymph node metastasis （85.0% vs. 60.6%, P=0.028）, and more cases belonging to TNM stages Ⅱ through Ⅳ（95.0% vs. 72.3%, P=0.025） than the NGC patients. Moreover, no significant difference existed between MGC and NGC patients in age, gender, tumor location, distant metastasis, as well as the rate of curative resection. There was significant difference between the MGC and NGC cases in the maximal diameter （P=0.008）, thickness （P=0.001）, gross appearance type （P=0.037）, and enhancement pattern （P=0.000） of the tumors on axial CT image. Conclusions Mucinous gastric carcinomas are rare and detected usually in advanced stages. The diagnostic sensitivity of mucinous gastric carcinoma by endoscopic biopsy specimens is relatively low, while MSCT is helpful in distinguishing mucinous from nonmucinous gastric carcinoma.