胃胰腺异位(Ⅲ型)伴上皮癌变临床病理观察

Adenocarcinoma arising in gastric heterotopic pancreas type Ⅲ

目的探讨胃胰腺异位(Ⅲ型)上皮癌变的临床病理特征和鉴别诊断。方法对1例胃胰腺异位(Ⅲ型)上皮癌变病例进行临床资料分析、病理形态观察和免疫组化检测,并结合文献进行讨论。结果该病临床表现无特征性,常有胃潴留。胃镜示黏膜粗大伴糜烂,幽门狭窄,十二指肠无异常。镜检:腺上皮和平滑肌异型增生,增生腺上皮形成腺管状、乳头状并有明显异型性,其周见平滑肌束穿插,可累及全层,胃小弯淋巴结,网膜组织见异型腺上皮转移或种植。免疫组化:CK7(+),CK20(-)。结论胃胰腺异位(Ⅲ型)是少见的良性病变,其上皮恶变更为罕见,应与皮革胃、先天性幽门肥大及胃肠道间质瘤等相鉴别。

Objective To investigate the clinicopathological features and differential diagnosis of adenocarcinoma arising in gastric heterotopic pancreas （type Ⅲ ） （GHPA）. Methods A case of GHPA was analyzed by clinical data analyses, light microscopy and immunohistochemieal staining with the literature review. Results Most cases were incidental findings, hut some were large enough to result in gastric obstruction. Gastroduodenoscopy revealed stricture, mucosa enlargement and anabrosis in the pyloric canal. The duodenum appeared unremarkable. Histopathologic examination revealed that the full-thickness of the pylorus was thickened by an adenomyomatous proliferation of smooth muscle, duct structures, and cysts. The epithelial proliferation and atypical hyperplasia of the duct were revealed. Lymph node metastasis and omemta implantation were identified. The neoplastic cells and the normal duct epitheliums showed a diffusedly strong positivity for cykeratin 7 and negativity for cytokeratin 20 by immunohistochemical staining. Conclusion The gastric heterotopie pancreas represents an unusual disease entity, and adenocarcinoma arising in gastric heterotopic pancreas （type Ⅲ） is rare. The linitis plastica, inborn pylorus hypertrophy and gastrointestinal stromal tumor should be differentiated from malignant gastric adenomyoma.