Discrepancies in the histologic type between biopsy and resected specimens:A cautionary note for mixed-type gastric carcinoma

AIM: To evaluate discrepancies between biopsy and resected specimens using the Japanese Classification of Gastric Carcinoma(JCGC) and tumor-node-metastasis(TNM) classification.METHODS: A total of 376 consecutive paired samples from biopsy and resected gastric specimens, which were derived from curative gastrectomy for gastric cancer between 2008 and 2011, were retrospectively analyzed.RESULTS:(1) Discrepancies in the histologic type were observed between biopsy and resected specimens; 11.7%(44/376) in the JCGC and 18.1%(68/376) in TNM. In specimens diagnosed as the differentiated type from biopsy specimens, 14.4%(28/195) in the JCGC and 41.1%(67/163) in TNM were finally diagnosed as the undifferentiated type from resected specimens; and(2) the incidence of mixed-type gastric cancer was significantly higher in specimens with discrepancies than in those without in both the JCGC and TNM(both P < 0.0001); 93.2%(41/44) of specimens with discrepancies in the JCGC and 97.1%(66/68) of specimens with discrepancies in TNM were mixed-type gastric cancers. CONCLUSION: Mixed-type gastric cancer was associated with a high incidence of histologic discrepancies between biopsy and resected specimens in both the JCGC and TNM definitions. Care should be taken in deciding treatments based on diagnosis of the histologic typefor mixed-type gastric cancer from biopsy specimens.

Histopathological characteristics of needle core biopsy and surgical specimens from patients with solitary hepatocellular carcinoma or intrahepatic cholangiocarcinoma

BACKGROUND Pathological manifestations of hepatic tumours are often associated with prognosis. Although surgical specimens(SS) can provide more information,currently, pre-treatment needle core biopsy(NCB) is increasingly showing important value in understanding the nature of liver tumors and even in diagnosis and treatment decisions. However, the concordance of the clinicopathological characteristics and immunohistochemical(IHC) staining between NCB and SS from patients with hepatic tumours were less concerned.AIM To introduce a more accurate method for interpreting the IHC staining results in order to improve the diagnostic value of hepatic malignancy in NCB samples.METHOD A total of 208 patients who underwent both preoperative NCB and surgical resection for hepatocellular carcinoma(HCC) or intrahepatic cholangiocarcinomaRESULTS Morphologically, the presence of compact tumour nests or a cord-like structure in NCB was considered the primary cause of misdiagnosis of HCC from ICC. The kappa statistic showed a moderate agreement in histomorphology(k = 0.504) and histological grade(k = 0.488) between NCB and SS of the tumours. A 4-tier(+++,++, +, and-) scoring scheme that emphasized the focal neoplastic cell immunoreactivity of tumour cells revealed perfect concordance of CK19, GPC3 and HepPar1 between NCB and SS(k = 0.717; k = 0.768; k = 0.633). Furthermore,with the aid of a binary classification derived from the 4-tier score, a high concordance was achieved in interpreting the IHC staining of the three markers between NCB and final SS(k = 0.931; k = 0.907; k = 0.803), increasing the accuracy of NCB diagnosis C(k = 0.987; area under the curve = 0.997, 95%CI: 0.990-1.000; P< 0.001).CONCLUSION These findings imply that reasonable interpretation of IHC results in NCB is vital for improving the accuracy of tumour diagnosis. The simplified binary classification provides an easy and applicable approach.

Clonal immunoglobulin heavy chain and T-cell receptor γ gene rearrangements in primary gastric lymphoma

AIM:To study the diagnostic value of immunoglobulin heavy chain(IgH)and T-cell receptorγ (TCR-γ)gene monoclonal rearrangements in primary gastric lymphoma(PGL).METHODS:A total of 48 patients with suspected PGL at our hospital were prospectively enrolled in this study from January 2009 to December 2011.The patients were divided into three groups(a PGL group,a gastric linitis plastica group,and a benign gastric ulcer group)based on the pathological results(gastric mucosal specimens obtained by endoscopy or surgery)and follow-up.Endoscopic ultrasonography(EUS)and EUSguided biopsy were performed in all the patients.The tissue specimens were used for histopathological examination and for IgH and TCR-γ gene rearrangement polymerase chain reaction analyses.RESULTS:EUS and EUS-guided biopsy were successfully performed in all 48 patients.In the PGL group(n=21),monoclonal IgH gene rearrangements were detected in 14(66.7%)patients.A positive result for each set of primers was found in 12(57.1%),8(38.1%),and 4(19.0%)cases using FR1/JH,FR2/JH,and FR3/JH primers,respectively.Overall,12(75%)patients with mucosal-associated lymphoid tissue lymphoma(n=16)and 2(40%)patients with diffuse large B-cell lymphoma(n=5)were positive for monoclonal IgH gene rearrangements.No patients in the gastric linitis plastica group(n=17)and only one(10%)patient in the benign gastric ulcer group(n=10)were positive for a monoclonal IgH gene rearrangement.No TCRgene monoclonal rearrangements were detected.The sensitivity of monoclonal IgH gene rearrangements was 66.7%for a PGL diagnosis,and the specificity was96.4%.In the PGL group,8(100%)patients with stage IIE PGL(n=8)and 6(46.1%)patients with stage IE PGL(n=13)were positive for monoclonal IgH gene rearrangements.CONCLUSION:IgH gene rearrangements may be associated with PGL staging and may be useful for the diagnosis of PGL and for differentiating between PGL and gastric linitis plastica.

胃黏膜活检标本规范化处理对病理诊断病变检出率的影响

目的 分析胃黏膜活检标本规范化处理对病理诊断病变检出率的影响。方法 200例接受胃镜检查并取活检的患者,对内镜下判断胃黏膜疑似存在神经内分泌瘤、淋巴瘤、癌、高级别上皮内瘤变、低级别上皮内瘤变、肠化、萎缩及炎症的病变进行活检,每例患者病变部位选取两份标本,其中一份标本给予常规活检标本处理,并将处理结果作为对照组(200份);另一份标本给予规范化的活检标本处理,并将处理结果作为观察组(200份)。对比两组测定标本的大小,形态及病理诊断结果差异。结果 测定后,观察组诊断标本大小(4.89±0.3)mm显著大于对照组的(2.48±0.25)mm,差异有统计学意义(P<0.05);观察组标本形态平坦状占比95.50%显著高于对照组的2.00%,弧形状占比2.00%、团块状占比2.50%显著低于对照组的32.50%、65.50%,差异有统计学意义(P<0.05)。测定后,两组病理结果中神经内分泌瘤、淋巴瘤、癌、高级别上皮内瘤变检出率对比,差异无统计学意义(P>0.05);观察组病理诊断结果中低级别上皮内瘤变、肠化、萎缩、炎症检出率分别为8.00%、32.50%、44.00%、57.00%,显著高于对照组的3.00%、19.00%、25.00%、32.50%,差异有统计学意义(P<0.05)。结论 胃黏膜活检标本规范化处理能够使标本的形态更为规范化,有助于对病理的诊断鉴别,临床应用价值显著。

Telomerase activity in endoscopic biopsy specimens of gastric mucosa

Objective To evaluate the role of telomerase activity in the developmen t and progression of gastric cancer. Methods Telomerase activity in 72 specimens obtained from endoscopic bi opsy in Southwest Hospital from October to December, 1996, including 6 cases of chronic superficial gastritis (CSG), 35 cases of gastric polyp (GP), 3 cases of dysplasi a (Dys) and 20 cases of gastric cancer (GC), was examined with tolomeric repeat amplification protocol (TRAP). Meanwhile, clinicopathological data were compared with the frequency of telomerase activity in GC group. Results Telomerase activity was detected in 85% (17/20) Department of Gastroenterology, Southwest Hospital, the Third Military Medical U niversity, Chongqing 400038, China (Yang SM, Feng DC, Luo YH, Lu R, Liu WW and Q in R) This work was supported by the National Natural Science Foundation of China (No. 39670347). of GC, whereas telomerase activity was not detected in 6 cases of CSG. In addition, t elomerase activity was also found positive in 10 of 35 CAG, 1 of 6 IM, 1 of 3 Dys and 2 cases of G P specimens, although their levels might be much lower than that in GC. Positive rate was significantly lower in CSG group, as well as in CAG or IM group than i n GC group (P<0.01). Owing to the limited cases, there was no s ignificant difference between CSG group and CAG, IM, Dys or GP group (P >0.05). Frequency of telomerase activity in GC was not correlated with p atient's sex, tumor's location, size, gross type or differentiation. Conclusions The expression of telomerse activity may play a curcial rol e in the process of gastric tumorigenesis. Detection of Telomerase activity in endoscopi c biopsy specimens may be helpful in predicting malignant change of gastric muco sa and early diagnosis of gastric cancer.

胃镜活检病理诊断上皮内瘤变高级别的意义

目的探讨胃镜活检上皮内瘤变高级别的临床病理诊断意义。方法常规HE切片观察143例胃镜活检病理诊断为上皮内瘤变高级别病例的病理形态特点,并与60例手术切除和13例重复活检后的病理诊断相对照。结果60例手术切除标本中,6例术后标本未发现有癌变组织,其余54例均病理诊断证实为腺癌,进展期和早期癌各27例;其中高分化腺癌15例,中分化腺癌24例,低分化腺癌12例,黏液腺癌3例。13例重复活检的患者中,4例诊断为高分化腺癌,8例为上皮内瘤变低级别,1例为慢性炎。6例术后未发现有癌变的活检标本均有类似肠道腺瘤样的病理改变,其中5例无黏膜肌。9例活检组织中伴有纤维间质反应的病例,术后病理诊断均为腺癌。结论胃镜活检病理诊断上皮内瘤变高级别时90%已同时伴有腺癌,胃镜活检的部位和深度对病理诊断有很大影响,纤维间质反应是胃镜活检病理诊断胃癌的重要形态学指标。

胃黏膜活检中黏液细胞癌的临床病理特点

目的 分析胃黏膜活检中黏液细胞癌的病变特点 ,总结其临床病理特征 ,避免误诊漏诊。方法 通过组织病理学和组织化学PAS、AB染色法 ,对 93例胃黏液细胞癌黏膜活检标本进行病理观察。结果 根据组织学特点 ,将癌组织分布形式分为黏膜固有层浅层、黏膜固有层深层、弥漫分布、黏膜边缘及坏死组织周围 5种病变类型 ,其在 93例标本中分别占 8 6 %、31 2 %、30 1%、11 8%和 18 3%。每种黏液细胞癌类型的细胞形态、排列方式及细胞周围的组织变化均有所不同 ,其癌细胞也具有不同的形态特征和黏液分泌特点。结论 胃黏液细胞癌的形态特征与组织分布具有相对的特殊性 。

老年胃癌活检标本与手术切除胃癌组织p53、c-erbB-2、p21、nm23基因表达检测的比较研究

目的探讨胃镜活检标本与手术切除胃癌组织p53、c-erbB-2、p21、nm23联合基因产物表达检测对胃癌诊断与治疗的价值.方法应用免疫组化技术检测了胃癌胃镜活检标本及手术切除胃癌组织p53、c-erbB-2、p21、nm23等基因产物表达并对胃镜活检标本与手术切除胃癌组织的检测结果进行了比较.结果 p53蛋白表达阳性率38.0%～46.2%,c-erbB-2为36.5%～59.2%,p21为39.4%～69.2%,nm23为34.6%～71.8%,在非胃癌组织(胃、十二指肠溃疡、胃息肉、重度不典型增生胃炎)未见c-erbB-2、p21、nm23等基因表达.c-erbB-2、p21的表达与胃癌的分化程度有关,p21、nm23基因表达与肿瘤浸润深度、肿瘤转移程度有关.p53、c-erbB-2、p21、nm23四种肿瘤蛋白在胃镜活检标本和手术切除标本中表达无显著性差异,胃镜活检标本和手术切除标本四种基因产物表达检测阳性符合率分别为92.2%、 85.5% 、96.9和 94.2% .结论对胃癌组织尤其胃癌胃镜活检标本p53、c-erbB-2、p21、nm23基因表达检测在胃部良恶性肿瘤鉴别、非手术临床分期的判断及指导临床治疗等方面具有一定价值.

胃黏膜组织DNA含量对胃癌诊断和预后判断的价值

目的 探讨胃黏膜活检组织中DNA含量对胃癌的早期诊断、鉴别诊断及预后判断的价值。方法 采用流式细胞仪测定 114例胃癌及各型胃炎患者胃黏膜活检组织的DNA含量 ,并与病理检查结果进行比较。结果 ①流式细胞术与病理检查结果的总符合率为 85 .96 %( 98/114 ) ,且有异倍体的非肿瘤组织可能存在较高的恶变可能性 ;②高分化肿瘤组织的DNA异倍体发生率与中分化及低分化或未分化的肿瘤相比 ,分别有显著性差异 (P <0 .0 5 )和非常显著性差异 (P <0 .0 1)。③有淋巴结转移及无淋巴结转移组DNA异倍体有非常显著性差异 (P <0 .0 1)。结论 采用流式细胞仪测定胃镜下活检胃黏膜组织的DNA含量来判断肿瘤良、恶性 ,其临床诊断与病理诊断有较高的符合率 ;在判断良性疾病癌变的可能性及预后判断上比病理诊断更有优势 ,可作为病理诊断的辅助方法应用于临床。

细胞凋亡及相关基因联合检测对胃黏膜癌前病变的诊断及癌变预测的意义

目的探讨细胞凋亡及相关基因的表达在胃黏膜癌变中的作用及对胃癌的预测和早期诊断的意义。方法对胃镜活检确诊为胃癌（胃癌组）及不典型增生（分为轻、中、重度不典型增生组）的标本应用TUNEL法检测细胞凋亡，应用免疫组化法检测p16、bcl-2、raa、c—myc、p53基因的表达。结果p16、bcl-2、ras、c-myc和p53基因表达率在轻、中、重度不典型增生组和胃癌组分别为69．23％，30．77％，38．46％，23．08％，7．69％；50．00％，37．50％，81．25％，43．75％，18．75％：36．36％．63．64％．81．82％．72．73％，45．45％：27．50％，67．50％，95．00％。90．00％，60．00％。轻度不典型增生组与胃癌组比较，差异有统计学意义（P〈0．05）；ras、c—myc和p53基因表达率轻度不典型增生组与重度不典型增生组比较，差异有统计学意义（P〈0．05）；p53与c—myc基因表达率中度不典型增生组与胃癌组比较，差异有统计学意义（P〈0．05）。p16、bcl-2、ras、c—myc和p53基因表达存在相关性。细胞凋亡指数胃癌组最低，轻、中度不典型增生组与胃癌组比较，差异均有统计学意义（P〈0．01）。轻度不典型增生组与重度不典型增生组比较，差异也有统计学意义（P〈0．01）。结论细胞凋亡指数减少及ras、bcl-2、c—myc、p16、p53基因的异常表达在胃黏膜癌变过程中发挥重要作用。中、重度不典型增生为重要的癌前病变。

聚合酶链反应快速检测胃活组织标本中的幽门螺杆菌

幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，ＨＰ）是一些胃、十二指肠疾病的主要原因之一。将聚合酶链反应（ｐｏｌｙｍｅｒａｓｅｃｈａｉｎｒｅａｃｔｉｏｎ，ＰＣＲ）应用于临床诊断，检测胃活组织标本中的幽门螺杆菌，取得了满意的结果。ＰＣＲ可检出少至０．１ｐｇＨｐＤＮＡ，相当于１００个细菌细胞。一次ＰＣＲ检测可在５小时内完成。我们以互补于Ｈｐ１６ＳｒＲＮＡ基因的一对寡核苷酸为引物，应用ＰＣＲ法对１２２个胃活组织标本进行了检测。其中６０个Ｈｐ分离株的ＤＮＡ和Ｈｐ标准株的ＤＮＡ，ＰＣＲ扩增产物经琼脂糖凝胶电泳均显示一条４６０ｂｐ的区带；而６２例非Ｈｐ感染的胃活组织标本及与Ｈｐ相关的肠道细菌，则不能扩增出该片段。以上１２２例中的６３例还做了另两种常规检测，其中３８例ＰＣＲ阳性，而血清学方法阳性仅３３例，组织学检查阳性仅２９例。在２０例经不同方案治疗后的胃肠疾病伴Ｈｐ感染病人中，被常规检测方法均认为是阴性，Ｈｐ已被根除的病人中，仍有２例ＰＣＲ检测为阳性。因此，虽然诊断Ｈｐ感染的方法已有很多，但共同的缺点是不能达到足够的灵敏性，特别是不能准确判断治疗后细菌是否被彻底根除。我们采用ＰＣＲ从胃活组织标本中检测Ｈｐ，并探讨它?

聚合酶链反应法快速检测幽门螺杆菌

设计一互补于幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，ＨＰ）脲酶Ｃ基因片段的引物，建立快速检测ＨＰ的ＰＣＲ方法。ＨＰ标准菌株和临床分离株基因组ＤＮＡ的ＰＣＲ扩增产物，经琼脂糖凝胶电泳显示３０１ｂｐ的特异区带，而其它几种常见的肠道菌均呈阴性。ＰＣＲ可检出少至１００个幽门螺杆菌细胞，并能用于临床胃粘膜活检标本中ＨＰ的检测，是一种快速、灵敏和特异的检测１ＩＰ的方法。

非小细胞肺癌纤支镜活检与手术标本的DNA含量比较研究

目的对比分析非小细胞肺癌纤支镜活检与相应手术标本的ＤＮＡ含量，以评价非小细胞肺癌纤支镜活检ＤＮＡ含量分析的可靠性。方法应用ＣＡＳ—２００型图像细胞仪对２２例非小细胞肺癌纤支镜活检标本和相应手术标本进行ＤＮＡ含量分析和比较研究。结果纤支镜组与手术组标本异倍体符合率为９１％，但手术组ＤＮＡ指数明显高于纤支镜组（Ｐ＜００５）。结论纤支镜活检标本的ＤＮＡ含量分析与手术标本一样可靠，ＤＮＡ倍体水平应是纤支镜活检ＤＮＡ含量分析的重要指标，不足之处为纤支镜活检的ＤＮＡ指数不如手术标本准确。

聚合酶链反应检测唾液幽门螺杆菌感染的应用

目的 探讨HP在胃粘膜以外的贮存地及口腔HP感染与胃内HP感染的关系。方法 应用聚合酶链反应(PCR)技术检测60例病人中48例胃粘膜组织HP阳性病人的唾液中HP感染情况。结果 48例胃粘膜组织HP阳性的病例中其唾液HP阳性44例,口腔唾液HP检出率91.5％(44/48)。12例胃粘膜组织HP阴性的病例仅3例唾液HP为阳性。 结论 HP还可存在于口腔唾液中,说明还存在口—口传播途径;另外根治HP后病人的再感染亦与口腔中HP的存在有关。

两种方法获得的非小细胞肺癌标本病理结果的差异

目的探讨CT引导下经皮肺穿刺活检标本病理结果的可靠性,及其对非小细胞肺癌的诊断价值。方法选择非小细胞肺癌患者91例,影像学检查发现肺部肿物,经痰液细胞学、支气管镜的涂片细胞学或活检组织学等检查,均未能明确诊断的肺部病变患者,后经CT引导下经皮肺内病灶穿刺术,获得涂片细胞学和(或)活检组织学证据,明确诊断为非小细胞肺癌,再行外科手术切除获得完整的病理结果。比较CT引导下经皮肺穿刺活检不同病理类型及不同途径的病理结果与外科手术切除标本的病理结果的差异。结果 CT引导下经皮肺穿刺活检的病理结果与手术结果的符合率为86.81%(79/91)。与手术病理结果比较,经皮肺穿刺活检不同病理类型的符合率差异无统计学意义[鳞癌vs腺癌vs腺鳞癌:88.57%(31/35)vs 86.27%(44/51)vs 80.00%(4/5),χ2=0.310,P>0.05];经皮肺穿刺标本采用不同方法的病理类型结果与手术结果的比较差异有统计学意义(χ2=9.698,P<0.05),经涂片细胞学+活检组织学获得病理结果的符合率[94.4%(51/54)]高于单独涂片细胞学[60.0%(6/10)]和单独活检组织学[81.4%(22/27)]。结论CT引导下经皮肺穿刺活检对非小细胞肺癌的定性诊断是可靠的,但其病理类型结果可能与手术结果不一致。

胃癌患者术前胃镜活检病理与外科术后病理诊断结果的差异

目的探讨胃癌患者术前胃镜活检与外科术后病理诊断结果的差异。方法选取2012年3月—2017年3月本院收治的胃癌患者58例,对其术前进行胃镜活检,外科术后进行病理诊断,对比前后结果差异。结果术前胃镜活检诊断胃癌占比77.59%,疑似胃癌占比15.52%,排除胃癌占比6.90%;术后病理诊断胃癌占比89.66%,排除胃癌占比10.34%(P<0.05)。结论术前胃镜活检诊断结果与术后病理诊断结果存在一定差异,但其准确率仍较为理想,可以在术前起到一定参考作用。

胃癌前哨淋巴结活检的时间探讨

目的:探讨进展期胃癌(AGC)手术中亚甲蓝示踪前哨淋巴结活检(SLNB)的最佳时间。方法:对2003年2月～2007年3月收治的AGC手术中,将亚甲蓝-丝裂霉素溶液在癌灶周边浆膜侧分3～5点浆膜下注射。分别在5～10 min及2～4.9 min两个时间段切取SLN进行病理学检查。如果常规HE染色病理检查阴性,则加作免疫组化检查。比较两组SLN的数量,阳性发现及其与分站的关系。将入组的55例AGC按SLNB时间分为SLNB一组(5～10 min切取SLN)及SLNB二组(2～4.9 min切取SLN)。结果:(1)SLNB一组30例均有SLN发现,共找到SLN78枚,平均每例2.6枚,SLNB二组25例有15例发现SLN,共找到SLN16枚,平均每例0.64枚,P<0.05。(2)SLNB一组78枚SLN中肿瘤转移共66枚,7枚免疫组化检查发现,淋巴结转移阳性率84.6%。30例中有28例SLN转移,转移病例阳性率93.3%。SLNB二组16枚SLN中肿瘤转移共13枚,淋巴结转移阳性率81.3%。25例中有11例SLN转移,转移病例阳性率44%,两组转移SLN比较P>0.05,转移病例比较P<0.01。(3)SLN与淋巴结站组的关系分别是SLNB一组N1 60枚(76.9%)、N2 15枚(19.2%)、N3 3枚(3.8%),转移SLN数目与淋巴结分站的关系依此为N1 58枚(87.8%)、N2 5枚(7.5%)、N3 3枚(4.5%),SLNB二组1 15枚(93.7%)、N2 1枚(6.3%)、N3 0枚,转移SLN数目与淋巴结分站的关系依此为N1 2枚(92.3%)、N2 1枚(7.7%)、N3 0枚,组间比较P>0.05、组内比较P<0.05。结论:(1)用亚甲蓝-丝裂霉素溶液作为示踪剂进行SLNB,5～10 min切取的SLN数目多、阳性率高,对手术的指导价值大;(2)当手术中SLN出现在第三站时,及时改行扩大手术可望提高手术根治的效果。

胃镜活检与外科病理诊断胃癌临床对比分析

目的 对比分析胃镜活检与外科病理对胃癌诊断结果的差异. 方法选取2009年8月～2012年8月我院收治的胃癌患者47例,对胃镜活检和术后组织病理学进行对比分析. 结果以手术后组织病理学诊断结果为标准,胃镜活检的确诊率为78.7%,疑诊率为12.8%,未能确诊率为8.5%;胃镜活检确诊率以Borrmann I型病变最高为100%,其次分别为Borrmann Ⅱ型和Borrmann Ⅲ型,确诊率分别为75.0%和66.7%,最低的病变类型为Borrmann Ⅳ型,确诊率仅为20.0%;胃镜活检对分化型癌细胞的判断准确率较高（89.7%）,而对分化不良型癌细胞的判断准确率相对较低（37.5%）. 结论胃镜活检对于胃癌的诊断具有重要的临床价值,但取材有限,难以全面客观反映病变性质,特别对弥漫浸润型黏膜病变和分化不良型癌细胞的诊断误差较大,需要引起重视.

纤维内镜活检胃黏膜诊断胃癌的临床病理分析

目的:探讨纤维内镜活检查出胃癌的检出率及胃黏膜活检病理诊断中存在的问题。方法:对我科近三年胃黏膜活检1669例标本中诊断为胃癌的病理诊断结果进行回顾性分析。结果:诊断胃癌病例为148例,检出率为8.9%,年龄16-86岁,其中8例因需鉴别诊断、肿瘤组织量少等原因初诊为高级别异型增生可疑癌变或高级别异型增生,后经再次取材或胃切除手术后诊断为胃癌;2例初诊漏诊,后经复片后诊断为胃癌;所有胃黏膜活检病理诊断结果中有1例初诊为未分化胃癌,后行胃切除手术后修正诊断为恶性淋巴瘤。结论:纤维内镜对胃癌的检出具有重要价值,是一种非常有效的检查方法;胃黏膜活检病理诊断虽常见,但实际诊断中仍存在不少问题。

人类表皮生长因子受体2表达与胃癌组织学的相关性研究

目的分析内镜下不同活检部位胃癌组织中人类表皮生长因子受体2(HER2)表达阳性率及与胃癌组织学特点相关性。方法收集本院2017年1月至2020年1月收治的胃癌患者87例列入胃癌组,选取同期住院治疗的慢性浅表型胃炎患者21例列入正常胃黏膜组,入院后将内镜或手术获得的标本行病理检查,比较内镜标本中不同活检部位组织的HER2阳性率和胃癌病理学特征与人类表皮生长因子受体2表达水平的关系。结果胃癌组HER2阳性率较胃黏膜正常组更高(17.2%和0.0%,P<0.05),内镜下肿瘤浅表弥漫部、溃疡隆起部、溃疡床及肿块突起部组织HER2阳性率分别是100%、90%、44%、100%,病理类型为管状腺癌及镜下不含印戒细胞较其他组织类型癌和镜下含印戒细胞HER2阳性率高(分别是23.0%、23.6%和3.8%、6.3%,P<0.05)。结论胃癌HER2表达水平与其病理组织学特点具有相关性,镜下不含印戒细胞的胃癌组织HER2阳性率可能更高,在评估内镜活检标本HER2表达时应着重选择肿瘤浅表弥漫部和肿块突起部,可以为胃癌靶向治疗提供参考。