42例早期胃癌临床病理特点

The clinical pathology characteristic of 42 example early time stomach cancer

目的观察早期胃癌胃镜、临床病理特点，探讨其病理诊断。方法将收集42例早期胃癌临床、胃镜及组织病理特点进行观察，采用免疫组化S-P法检查C—erbB-2、P53、Ki-67的表达。结果早期胃癌临床表现无特异性，主要为腹痛腹胀不适，部分消瘦食欲减退，呕血便血等，胃镜主要表现为糜烂平坦型23例（54．8％）隆起型17例（40．5％），病变部位胃窦最多29例、胃角5例、胃体6例，胃底贲门部2例。组织类型：管状腺癌24例，黏液腺癌2例，印戒细胞癌7例，低分化腺癌9例，伴有肠上皮化生15例，不典型增生14例。黏膜内癌26例，黏膜下层16例，伴有淋巴结转移6例。C—erbB-2阳性表达占16．7％（7／42），Ki-67阳性表达占38．1％（16／42）、P53阳性表达占30．9％（13／42）。结论早期胃癌临床表现隐匿，无特异性，不足以引起患者和临床医生的重视。对胃癌高危患者积极开展定期胃镜检查是提高早期胃癌检出率的关键，是早期胃癌确诊的的最佳方法，C—erbB．2阳性表达与淋巴结转移有关。早期胃癌是一种多因素，多基因，多步骤共同作用复杂过程。

Objective To observe early gastric endoscopy, clinical and pathological features of the pathological diagnosis. Methods 42 cases of early gastric cancer of clinical, endoscopic and pathological features was observed, C-erbB2, P53, Ki-67 expression were detected by immunohistochemical sp method. Results The resuhs of early gastric cancer had no specific, mainly abdominal pain and bloating discomfort, some weight loss loss of appetite, vomiting blood in the stool, etc. , endoscopy showed erosive fiat major, 23 cases （54. 8% ）protruded in 17 cases （40. 5% ） , lesions up to 29 cases of gastric area, gastric angle in 5 cases, 6 cases of gastric body and gastric cardia in 2 patients. Organization type： tubular adenocarcinoma, 24 cases,2 cases of mucinous adenocarcinoma, signet ring cell carcinoma in 7 cases, 9 cases of poorly differentiated adenocarcinoma, 15 cases associated with intestinal metaplasia, dysplasia in 14 cases. Mucosal carcinoma in 26 patients, submucosa in 16 cases, 6 cases with lymph node metastasis. C-erbB-2 expression accounted for 16. 7% （7/42） , Ki-67 expression accounted for 38.1% （ 16/42）, P53 expression accounted for 30.9% （13/42）. Conclusion The clinical manifestations of early gastric cancer is hidden, non-specific, not enough to cause at- tention to patients and clinicians. High risk of gastric cancer patients with gastroscopy active on a regular basis to improve the detection rate of early gastric cancer is the key to the early diagnosis of gastric cancer. C-erhB-2 expression is related to lymph node metastasis. Factors of early gastric cancer is a multl-step interaction of multiple genes and more complex process.