自身免疫性胃炎的临床病理学特征分析

Clinicopathological features of autoimmune gastritis

目的:探讨自身免疫性胃炎的临床病理学特征、诊断及鉴别诊断。方法:分析广东省人民医院2018年1月至2019年3月收集的14例自身免疫性胃炎患者的临床表现、内镜改变及活检标本病理形态学改变,并复习相关文献。结果:14例自身免疫性胃炎患者表现为非特异性的胃肠道症状,血清学检测均显示抗壁细胞抗体阳性和/或抗血清内因子抗体阳性。12例为女性,2例为男性,年龄41~79岁,平均年龄55岁。其中7例伴有不同程度的贫血;2例患者合并幽门螺杆菌感染。14例患者中有2例内镜下可见多个息肉状广基隆起(直径0.2~0.9 cm),组织学诊断为多发神经内分泌瘤;2例胃体/胃底见10余个形态不规则隆起型肿物(直径0.8~3.5 cm),组织学诊断为多发增生性息肉。14例组织病理学特征为以胃体/胃底黏膜慢性炎性病变为主,具有不同程度的胃底腺萎缩,伴有不同程度的肠上皮化生、假幽门腺化生、胃小凹增生及胰腺腺泡化生。嗜铬粒素A或突触素免疫组织化学检测显示所有病例均有胃体神经内分泌细胞线状和/或微结节状增生,而胃泌素免疫组织化学检测显示胃窦黏膜内G细胞增生。所有病例胃窦黏膜无明显炎性病变或呈轻度慢性炎。2例属于早期病变,6例属于旺炽期病变,6例属于末期病变。结论:自身免疫性胃炎患者的临床症状不一,部分较隐匿,内镜表现呈多样性,不同的临床阶段,具有不同的组织学改变。病理医师应提高对自身免疫性胃炎的形态学认识,避免漏诊、误诊,使患者能够得到及时、恰当的治疗。

ObjectiveTo study the clinicopathological characteristics and pathologic diagnosis of autoimmune gastritis.MethodsFourteen biopsies of autoimmune gastritis were collected from January 2018 to March 2019 at Guangdong Provincial People′s Hospital.Their clinical data,histological features and immunohistochemical(IHC)results were analyzed,with review of relevant literature.ResultsAll 14 patients′ages ranged from 41 to 79 years(mean 55 years).There were 12 females and 2 males.All patients had non-specific symptoms,but they all had positive serum anti-parietal cell antibody and/or anti-intrinsic factor antibody.Seven patients had variable degree of anemia.Two patients had concomitant H.pylori infection.Two patients presented with multiple protruding polyps in corpus/fundus,0.2 to 0.9 cm in diameter,or multiple large lobulated and broad based polyps(0.8 to 3.5 cm in diameters).The former cases were diagnosed as type 1 neuroendocrine tumors,the latter were multiple hyperplastic polyps.Microscopically,autoimmune gastritis showed typical morphology,characterized by diffuse corpus-restricted atrophic gastritis with variable proportions of intestinal metaplasia,or pseudopyloric metaplasia,pancreatic,acinar metaplasia,foveolar hyperplasia and hyperplasia of the endocrine-like cells(ECL cells).Hyperplasia of ECL cells often needed IHC staining to confirm.CgA/Syn IHC stain highlighted linear and micronodular ECL cell hyperplasia.In the absence of concurrent or past H.pylori infection,the antrum was usually normal.Gastrin IHC stain showed hyperplasia of gastrin-producing cells(G cells)in the antrum.Two cases were in the early phase,six were in florid phase,and six were end phase.ConclusionsMost patients of autoimmune gastritis have non-specific symptoms or are asymptomatic and show various endoscopic findings.There are three histologic phases of autoimmune gastritis.Recognition of this entity would be beneficial for pathologists to avoid misdiagnosis.Pathologists can make preferred diagnosis of autoimmune gastritis depending on the histologic clues and prompt appropriate and timely management for the patients.