利用数字切片技术对120例胃腺瘤进行临床病理特征分析

Research on the summarization of clinicopathological characteristics of 120 cases of gastric adenoma with the digital slicing technique

目的:分析胃腺瘤的临床病理特征,为临床诊治研究和精准诊疗提供参考。方法:收集陕西省人民医院病理科组织病理诊断为胃腺瘤的病例120例,利用数字切片观察胃腺瘤的组织病理及免疫组化表达特征,分析总结胃腺瘤病例临床病理特征。结果:120例病例中肠型腺瘤110例,患者平均年龄65.72岁,男女比例3:2,其中69%病例发生于远端胃窦、胃角,肿瘤平均直径1.46 cm,77.2%的病例肿瘤周围黏膜呈慢性炎改变并见肠化生改变,其中26例伴有高级别异型增生,16例伴有黏膜内癌,1例伴有腺癌侵及黏膜固有层;小凹型腺瘤7例,患者平均年龄56岁,男女比例1:6,其中5例发生于胃底体,肿瘤平均直径0.69 cm,周围黏膜均未见肠化生及高级别异型增生改变,其中4例呈多发改变,并伴有增生性息肉及胃底腺息肉改变;幽门腺腺瘤2例,患者平均年龄61.5岁,男女比例1:1,均发生于胃底体,肿瘤平均直径4.4 cm,周围黏膜均未见肠化生改变,均伴有高级别异型增生;泌酸性腺瘤1例,患者女性,年龄72岁,发生于胃底,肿瘤单发直径0.4 cm,周围黏膜未见肠化生改变。免疫组化特征:肠型腺瘤MUC5AC、MUC6均为阴性,MUC2部分表达;小凹型腺瘤呈MUC5AC阳性表达,不表达MUC2;幽门腺腺瘤表达MUC6,部分表达MUC5AC,不表达MUC2;泌酸性腺瘤主细胞分化的瘤细胞特征性表达MUC6,MUC5AC主要表达于瘤体正常表面黏液细胞,不表达MUC2。结论:发生于胃的腺瘤,其不同病理学类型、组织学形态及免疫组化表达均有特征性差异,其预后及危险度均不同,应给予准确病理诊断和不同的临床处理。利用数字切片技术有助于肿瘤病理的回顾性分析。

Objective To analyze the clinicopathological characteristics of gastric adenoma.Methods 120 cases of gastric adenoma diagnosed by hisopathology in the Pathology Department of Shaanxi Provincial People's Hospital are collected.The histopathological and immunohistochemical expression characteristics of gastric adenoma are observed by digital slicing,and the clinicopathological characteristics of gastric adenoma are analyzed and summarized.Results Among the 120 cases,there are 110 cases of mesenteric adenoma.The average age of patients is 65.72 and ratio of men to women is 3:2.69%of the cases occurred in the distal stomach(gastric antrum and gastric angle).The average diameter of tumors is 1.46cm.In 77.2%of the cases,the mucosa around the tumor has chronic inflammatory changes and intestinal metaplasia changes.26 cases have high-grade dysplasia.16 cases have intramucosal carcinoma.1 case has adenocarcinoma invasion and lamina propria of mucosa.There are 7 cases of pit adenoma.The average age of patients is 56 and the ratio of men to women is 1:6.Among them,5 cases occurin the fundus of the stomach.The average diameter of the tumors is 0.69cm.No intestinal metaplasia or high-grade dysplasia change is observed in the mucosa surrounding the tumor.4 cases have multiple changes accompanied by hyperplastic polyps and changes in polyp of the fundus gland.There are 2 cases of pyloric gland adenoma.The average age of the patients is 61.5.The ratio of men to women is 1:1.They all occur in the fundus of the stomach.The average diameter of the tumor is 4.4cm.No intestinal metaplasia is observed in the surrounding mucosa.They are all accompanied by high-grade dysplasia.There is one case of acid-secreting adenoma.The patient is female and 72 years old.It occur in the fundus of the stomach.The diameter of a single tumor is 0.4cm.No intestinal metaplasia is observed in the surrounding mucosa.Immunohistochemical characteristics:Intestinal adenoma MUC5AC and MUC6 are negative,and MUC2 is partially expressed;the pit adenoma has the positive expression of MUC5AC and MUC2 is not expressed;the pyloric gland adenoma expresses MUC6,partially expresses MUC5AC,and does not express MUC2;and the tumor cells differentiated from main cells of acid-secreting adenoma have the characteristic expression of MUC6 and MUC5AC is mainly expressed in normal surface mucous cells of the tumor,but MUC2 is not expressed.Conclusion Gastric adenomas with different pathological types have characteristic differences in histological morphology and immunohistochemical expression.Their prognosis and risk are different,so accurate pathological diagnosis and different clinical management is required.The digital slicing technique is helpful to the retrospective analysis of tumor pathology.