低级别内瘤变的早期胃癌1例报道并文献复习

A case report of early gastric cancer with low grade internal neoplasia and literature review

胃黏膜低级别病变(LGIN)属于癌前病变,具有癌变的潜能。LGIN长期临床转归有两种结局,部分可发生逆转,部分有恶变的潜力,故而对临床处理造成困扰。在临床工作中,是密切随访还是进行一定的干预措施,需要进一步探讨。本文报道一例多次胃镜及病理检查诊断为慢性萎缩性胃炎伴低级别内瘤变(轻度异性增生),2021年复查胃镜再次行黏膜活检仍然是“中度慢性萎缩性胃炎伴轻度异性增生”,然而经蓝光成像放大内镜观察考虑病灶微血管、微结构紊乱。病灶呈表面发红的凹陷型改变,并且病灶范围与2018-2020年间相比明显扩大,>2 cm。高度考虑早期胃癌,最终行经内镜下黏膜剥离术(ESD)诊断性切除后,病理证实为早期胃癌,通过本案例报道及复习文献,为临床医生在LGIN的诊治上提供经验和借鉴。

Low grade intraepithelial neoplasia of gastric mucosa(LGIN)is precancerous,which has the potential to become cancerous.However,the long-term clinical outcome of LGIN has two conditions,some of which can be reversed,and some have the potential for malignant transformation,thus causing difficulties in clinical management.Whether to follow up closely or carry out certain intervention measures needs to be further discussed.The case was diagnosed as chronic atrophic gastritis with low-grade internal neoplasia(mild heterosexual hyperplasia)by gastroscopy and pathological repetitious examinations in this paper.In 2021,the second mucosal biopsy performed by gastroscopy was still"moderate chronic atrophic gastritis accompanied by mild heterosexual hyperplasia".However,the microvessels of the lesion were considered a disorder through the observation of blue light imaging magnifying endoscopy Microstructure.The lesion showed a concave change with redness on the surface,and the scope of the lesion was significantly enlarged compared with the period from 2018 to 2020,and was>2 cm.Early gastric cancer was highly considered and finally diagnosed by endoscopic mucosal dissection(ESD).This case report and literature review provide experience and reference for clinicians in the diagnosis and treatment of LGIN.