深在性囊性胃炎16例临床病理分析

Gastritis cystica profunda: a clinicopathologic analysis of 16 cases

目的探讨深在性囊性胃炎(GCP)临床症状、胃镜特点、病理形态特点及鉴别诊断。方法回顾性分析16例GCP临床病史及病理组织学特点,并复习相关文献。结果 16例患者中,以男性为主,平均发病年龄60.4岁。最好发部位为胃底(37.5%)。16例患者均无胃部手术史,临床症状多不典型,胃镜亦不能做出GCP的诊断。胃黏膜腺体以位于黏膜下层为主,可达深肌层。病理学形态除GCP典型表现外,伴有表面黏膜不同程度异型增生共11例,包括低级别2例,高级别4例,癌变5例。深在腺体出现异型增生的有4例,其中低级别2例,高级别2例,均同时具有表面腺体高级别异型增生。16例患者中仅1例行活检钳除术,其余行外科手术切除或内镜下黏膜切除术(EMR)/内镜下黏膜剥离术(ESD)。术后尚未发生严重并发症及复发,预后良好。结论 GCP临床症状及内镜表现均不典型,超声内镜结合EMR或ESD有利于疾病诊断。本文16例患者均无胃部手术史,与既往报道不一致。GCP发生机制及恶性潜能尚不明确,仍需要进一步研究。

Objective To study the clinical symptoms,gastroscopic presentation and pathological characteristics of gastritis cystica profund（ GCP） as well as its possible differential diagnosis. Methods We investigated the clinical history and histopathological changes in 16 cases of GCP,with review of related literatures. Results Among the 16 cases,GCP were more commonly found in men than in women,and the overall mean age was 60. 4 years. The most common anatomic location of GCP was the gastric fundus（ 37. 5%）. The patients in this study had no history of gastric surgery and specific symptoms. Gastroscopy cannot make a diagnosis of GCP. The presence of gastric glands was mainly noted in the submucosa of stomach,and could also deeply extend into muscular layer. In addition to the typical pathogical characteristics of GCP,there were 11 cases with different degrees of dysplasia within superficial mucosa,including 2 cases with low grade lesion,4 cases with high grade lesion,and 5 cases with carcinoma. There were 5 cases of dysplasia in the deep glands,including 2 cases with low grade lesion,2 cases with high grade,all with high grade dysplasia within superficial mucosa. All but one case resected by forceps were managed with definite surgical resection or endoscopic mucosal resection（ EMR）/endoscopic submucosal dissection（ ESD）. When complete excision was performed,there was no recurrences. Conclusions The clinical symptoms and gastroscopic observation of GCP are not typical. Endoscopic ultrasonography combined with EMR or ESD is beneficial to the diagnosis of diseases. None of the 16 patients in this cohort has a history of gastric surgery,which is inconsistent with previous reports. Further studies may help to elucidate the natural history of process and the possibility for malignant potential of GCP.