胃异位胰腺伴发导管腺癌临床病理分析

Clinicopathological features of adenocarcinoma arising in gastric heterotopic pancreas

目的探讨胃异位胰腺伴发导管腺癌的临床病理特征、诊断及鉴别诊断。方法根据1例胃异位胰腺伴发导管腺癌的病例,搜集整理患者的临床资料,对病理切片做形态学观察及免疫组化检测,复习文献进行分析讨论。结果患者临床症状无特异性,CT及胃镜显示在胃窦幽门黏膜下有一不规则形肿块。镜检:可见两种不同的区域:异位区,黏膜下可见胰腺腺泡及导管;癌变区,可见幽门胃壁显著增厚,管状囊状的导管腺体呈腺肌瘤样在平滑肌内穿插生长,导管上皮增生并有异型性。还可以观察到神经侵犯现象和胃周淋巴结转移灶。免疫组化染色肿瘤细胞显示:CK7、CK19、CEA、CA199(+),CK20(-)。结论对胃异位胰腺伴发导管腺癌的准确诊断需要结合病理形态以及免疫组化表型特点。

Objective To investigate the clinicopathological features and differential diagnosis of adenocarcinoma arising in gastric heterotopic pancreas.Methods A case of adenocarcinoma arising in gastric heterotopic pancreas was reported with the literature review.Results The patient had no specific symptoms.The computed tomograph(CT)scan and gastroduodenoscopy revealed a submucosal tumor with an irregular appearence in the gastric antrum.Two different portions were noted by histopathologic examination:the heterotopic area was submucous and composed of pancreatic acini and ducts;the cancerous region was thickened by an adenomyomatous proliferation of smooth muscle,duct structures and cysts.The ductal epithelial hyperplasia and dysplasia were revealed.The neural invasion and lymph node metastasis were identified.The neoplastic cells were diffusedly strongly positive for cykeratin 7,cykeratin 19,carcino-embryonic antigen(CEA),carbohydrate antigen 19-9(CA199)and negative for cytokeratin 20 by immunohistochemical staining.Conclusion The diagnosis of adenocarcinoma arising in gastric heterotopic pancreas depends on combinination of the pathological characteristics and immunophenotype.