胃泌酸腺肿瘤49例临床病理学分析

Clinicopathologic features of stomach oxyntic gland neoplasms on 49 patients

目的:分析胃泌酸腺肿瘤的临床病理学特征。方法:选取2016年1月—2020年12月于山东大学第二医院确诊的49例胃泌酸腺肿瘤包括泌酸腺腺瘤(OGA)和胃底腺型腺癌(GA-FG)为研究对象,回顾性分析其临床资料、内镜表现、组织学特征、免疫表型并进行随访。结果:胃泌酸腺肿瘤的患者年龄19~83岁,平均(57.3±2.4)岁,男女比例为24∶25。病变主要位于胃体(27/49)和胃底(15/49)。内镜下有4种表现:扁平隆起型、息肉样、扁平型和凹陷型。部分病变可见扩张的树枝状血管。48例为单发,病变最大径平均为(3.9±0.5)mm(1.0~7.0 mm)。7例表现为黏膜下浸润,浸润深度均小于500μm。该肿瘤由密集的腺体吻合呈条索状,镜下呈不规则分支状、迷路状。该类肿瘤细胞分化好,形态类似于泌酸腺细胞,以主细胞为主,细胞核轻度增大,有轻微异型性,核分裂像少见。免疫标志物MUC6(100%)和Pepsinogen-Ⅰ(83%)呈弥漫性阳性,H+/K+-ATPase不同程度阳性(58%)。结论:泌酸腺肿瘤是一种新的胃肿瘤组织学类型,具有独特的临床病理特征,该类肿瘤发病率较低,预后良好,但仍需长期随访。

Objective:To analyze the clinicopathological features of gastric oxyntic gland neoplasms.Methods:Forty-nine cases of stomach oxyntic gland neoplasms including oxyntic gland adenoma(OGA)and gastric adenocarcinoma of the fundic gland type(GA-FG)diagnosed in the Second Hospital of Shandong University from January 2016 to December 2020 were selected.The clinical information,endoscopic appearance,histological features and immunophenotype were analyzed retrospectively, and followed up. Results: Age of the gastric oxyntic gland neoplasm patients ranged from 19 to 83 years old, with an average age of (57.3±2.4) years old. The male-to-female ratio was 24∶25. Most of the lesions were located in the gastric body (27/49) and fundus (15/49). There were four endoscopic phenotypes: flat bulging, polypoid, flat and depression. In some lesions, there were dilated dendritic vessels. 48 cases were single onset. The mean maximum diameter of lesions was(3.9±0.5) mm (1.0~7.0 mm). Seven cases showed submucosal invasion, and the invasion depth was less than 500 μm. The tumor consists of the dense glandular and the glandular connects to form a strip shape, which is irregularly branched and labyrinthlike under the microscope. These tumor cells were well differentiated and the morphology was similar to oxyntic gland cells. The chief cells were the predominant cells. The nucleus was mildly enlarged with slight pleomorphism and the mitosis was uncommon. The oxyntic gland neoplasms of the stomach were diffusely positive for Mucin-6 (MUC6) (100%) and Pepsinogen I (83%), focally positive for H+/K+-ATPase (58%). Conclusions: The stomach oxyntic gland neoplasm is a new histology type with unique clinicopathological features. The incidence of this neoplasm is low and the prognosis is good but it still needs long-term follow-up.