十二指肠腺增生性病变18例临床病理分析

Clinicopathological analysis of 18 cases of Brunner’s gland proliferating lesions

目的探讨十二指肠腺增生性病变的临床病理学特点、免疫表型、诊断及鉴别诊断。方法回顾性分析18例十二指肠腺增生性病变的临床资料、病理学特征、免疫表型,并复习相关文献。结果患者发病年龄35~71岁,男、女性各9例。18例患者中十二指肠腺增生、十二指肠腺错构瘤各9例,两者的形态及病变大小无明显差异。十二指肠腺错构瘤的镜下表现比十二指肠腺增生多样,且其腺体可伴上皮内瘤变,免疫组化标记p53、Ki-67及Muc5AC可以辅助诊断。大部分十二指肠腺增生性病变的表面黏膜均有Muc5AC不同程度的表达,提示表面黏膜有不同程度的胃小凹化生,部分表面黏膜还可见糜烂及溃疡形成。结论十二指肠腺增生性病变临床罕见,包括十二指肠腺增生和十二指肠腺错构瘤,两者主要通过镜下形态特点进行鉴别。采用免疫组化检测可鉴别十二指肠腺的上皮内瘤变或原位癌变与硬化性改变;表面黏膜的胃小凹化生、糜烂及溃疡形成提示病变可能的发生、发展机制。

Purpose To investigating the clinicopathological features,immunophenotypes,diagnostic criteria and differential diagnosis of the proliferation lesions of the duodenal Brunner’s gland.Methods The clinical data,pathological features and immunophenotypes of 18 cases of Brunner’s gland proliferating lesions were analyzed retrospectively,and the relevant literatures were reviewed.Results The age of onset was 35 to 71 years old,in which 9 cases were female and 9 cases were male.Among the 18 patients,there were 9 cases of Brunner’s gland hyperplasia and 9 cases of Brunner’s gland hamartoma.There was no significant difference in the shape and size of the lesion between the two groups.The microscopic appearance of Brunner’s gland hamartoma was more diverse than that of Brunner’s gland hyperplasia,and the former could accompanied by intraepithelial neoplasia.The immunostaining of p53,Ki-67 and Muc5AC could assist in the diagnosis.Moreover,Muc5AC expression was also detected in the surface mucosa of almost all Brunner’s gland proliferating lesions,suggesting that there were different degrees of gastric foveolar metaplasia in the surface mucosa.Erosion and ulcer formation could also be observed in some of the cases.Conclusion Proliferating lesions of the Brunner’s gland,including Brunner’s gland hyperplasia and Brunner’s gland hamartoma,are rarely occurred,which are mainly differentiated by mocroscopic morphological charactreistics.Immunohistochemistry can play an auxiliary role in the diagnosis and differential diagnosis of intraepithelial neoplasia or carcinoma in situ of the Brunner’s gland.The gastric foveolar metaplasia,erosion and ulcer formation in surface mucosa may play a key role in the genesis and development of the lesions.