胃底腺黏膜型腺癌4例临床病理特征

Clinicopathological features of gastric fundus mucosal adenocarcinoma:report of four cases

目的观察胃底腺黏膜型腺癌(gastric adenocarcinoma of fundic-gland mucosa type,GA-FGM)的临床病理学特征。方法回顾性分析4例GA-FGM的临床病理资料,采用免疫组化EnVision法检测黏蛋白(MUC5AC、MUC6)表达,并复习相关文献。结果肿瘤向胃小凹上皮和胃底腺两种方向分化。胃小凹上皮分化部分由低度异型的高柱状肿瘤性上皮构成,可呈乳头状、绒毛状或管状形态,免疫组化标记MUC5AC阳性;胃底腺分化成分表现为向颈黏液细胞、主细胞和壁细胞分化,免疫组化标记MUC6阳性。结论GA-FGM具有独特的形态学特征,活检诊断困难,与胃底腺型腺癌形态学有重叠又有不同,需加强认识,免疫组化在鉴别诊断中起重要作用。

Purpose To observe the clinicopathological changes of gastric adenocarcinoma of fundic-gland mucosa type(GA-FGM).Methods The clinicopathological data of 4 cases of GA-FGM was analyzed retrospectively.The expression of MUC5AC and MUC6 was detected by immunohistochemical method,and review relevant literature.Results The tumor differentiated into gastric foveal epithelium and gastric fundus gland.The differentiated part of the pits consists of high columnar neoplastic epithelium with low atypia,which can be papillary,villous or tubular morphology.Immunohistochemical staining showed MUC5AC expression.The gastric fundus gland differentiated into cervical mucous cells,main cells and parietal cells,and was positive for MUC6 immunohistochemistry.Conclusion Gastric adenocarcinoma of fundic-gland mucosa type has unique pathologic characteristics,which is very difficult to diagnose in biopsy,and the morphology of GA-FGM overlaps with that of gastric fundus adenocarcinoma,so we need to strengthen our understanding.Immunohistochemistry plays an important role in differential diagnosis.