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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2020, Vol. 10 ›› Issue (06) : 279 -282. doi: 10.3877/cma.j.issn.2095-2015.2020.06.009

所属专题： 经典病例； 文献；

病例报告

胃底腺黏膜型腺癌一例报道并文献复习
张丽华1, 王硕2, 李义3, 刘倩2,†()   
  1. 1. 250031　济南，联勤保障部队解放军第九六〇医院病理科
    2. 250022　济南，山东省立医院西院病理科
    3. 250022　济南，山东省立医院西院消化内科
  • 收稿日期:2020-09-22 出版日期:2020-12-01
  • 通信作者: 刘倩

Gastric adenocarcinoma of fundic gland mucosa type-a case report and literature review

Lihua Zhang1, Shuo Wang2, Yi Li3, Qian Liu2,†()   

  1. 1. Department of Pathology, the 960th Hospital of the PLA, Jinan 250031, China
    2. Department of Pathology, Shandong Provincial Western Hospital, Jinan 250022, China
    3. Department of Gastroenterology, Shandong Provincial Western Hospital, Jinan 250022, China
  • Received:2020-09-22 Published:2020-12-01
  • Corresponding author: Qian Liu
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张丽华, 王硕, 李义, 刘倩. 胃底腺黏膜型腺癌一例报道并文献复习[J/OL]. 中华消化病与影像杂志(电子版), 2020, 10(06): 279-282.

Lihua Zhang, Shuo Wang, Yi Li, Qian Liu. Gastric adenocarcinoma of fundic gland mucosa type-a case report and literature review[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2020, 10(06): 279-282.

目的

探讨胃底腺黏膜型腺癌的临床病理学特征及免疫组化表型。

方法

总结山东省立医院西院病理科确诊的1例胃底腺黏膜型腺癌的临床及病理学资料，分析其组织形态学特点及免疫组织化学染色表达，并复习相关文献。

结果

老年女性，胃底大弯侧见直径2.0 cm的不规则表浅隆起，中央浅糜烂，行内镜下黏膜剥脱术，肿瘤组织镜下为中-高分化管状腺癌，伴有乳头状腺癌，免疫组化染色小凹上皮分化区域MUC5AC(＋)；胃底腺分化区域MUC6(＋)、pepsinogen-I(＋)；Ki-67指数约5%。

结论

胃底腺黏膜型腺癌是一种新的肿瘤类型，发病率极低，既有胃底腺型腺癌的内镜和病理特征，又有小凹上皮来源腺癌的内镜和病理特征；加强该肿瘤的认识有助于对其正确诊断与治疗。

关键词: 胃底腺黏膜型腺癌, 临床病理特征, 免疫组织化学, 诊断, 鉴别诊断
Objective

To explore the clinicopathological characteristics and immunohistochemical phenotypes of gastric adenocarcinoma of fundic gland mucosa type.

Methods

The clinical data, pathologic characteristics and immunohistochemical expression characteristics of one case of gastric adenocarcinoma of fundic gland mucosa type confirmed by Department of Pathology of Shandong Provincial Western Hospital were collected and analyzed, and related literatures were reviewed.

Results

An elderly women, with irregular superficial bulges of 2.0 cm in diameter on the greater curvature of the stomach fundus, superficial erosions in the center, underwent endoscopic submucosal dissection, tumor histologically showed moderate to well-differentiated tubular adenocarcinoma with papillary adenocarcinoma, immunohistochemistry showed MUC5AC(+ )in foveal epithelial differentiation area, MUC6(+ )and pepsinogen-Ⅰ(+ )in gastric fundus gland differentiation area, and Ki-67 index was about 5%.

Conclusion

Gastric adenocarcinoma of fundic gland mucosa type is a new type of tumor with a very low incidence.It has the endoscopic and pathological features of both gastric fundus adenocarcinoma and small concave epithelial-derived adenocarcinoma.Enhancing understanding of this tumor is helpful for correct diagnosis and treatment.

Key words: Gastric adenocarcinoma of fundic gland mucosa type, Clinicopathological features, Immunohistochemistry, Diagnosis, Differential diagnosis
图6 肿瘤细胞MUC5AC胞浆及胞膜阳性。EnVision法中倍放大
1
Fujiwara S, Yao K, Iwamura K，et al.M-NBI findings of gastric adenocarcinoma of fundic gland type and adenocarcinoma with differentiation towards the fundic mucosa [in Japanese][J]．Stomach Intest，2015,50:1548-1558.
2
Ueyama H, Yao T, Nakashima Y，et al.Gastric adenocarcinoma of fundic gland type(chief cell predominant type)：proposal for a new entity of gastric adenocarcinoma[J]．Am J Surg Pathol，2010,34(5):609-619.
3
Tanabe H, Iwashita A, Ikeda K，et al.Histopathological characteristics of gastric adenocarcinoma of fundic gland type [in Japanese][J]．Stomach Intest，2015,50:1469-1479.
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Takahashi K, Fujiya M, Ichihara S，et al.Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma：a case report[J]．Medicine(Baltimore)，2017,96(23):e7080.
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Uchida A, Ozawa M, Ueda Y, Murai Y，et al.Gastric adenocarcinoma of fundic gland mucosa type localized in the submucosa：a case report[J]．Medicine(Baltimore)，2018,97(37):e12341.
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Mizutani T, Araki H, Saigo C，et al.Endoscopic and Pathological Characteristics of Helicobacter pylori Infection-Negative Early Gastric Cancer[J]．Dig Dis，2020:1-10.
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Singhi AD, Lazenby AJ, Montgomery EA.Gastric adenocarcinoma with chief cell differentiation：a proposal for reclassification as oxyntic gland polyp/adenoma[J]．Am J Surg Pathol，2012,36(7):1030-1035.
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WHO Classification of Tumours Editorial Board.WHO Classification of Tumours.Digestive system tumours[M].5th ed.Lyon：LARC Press，2019：83-95.
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孙玮玮，张黎，顾敏敏，等．胃底腺型腺癌六例临床病理学特征[J]．中华病理学杂志，2020,343-347.
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Takashi Kanesake, NoriyaUedo, Kenshi Yao，et al.New subtype of gastric adenocarcinoma：mixed fundic and pyloric mucosa-type adenocarcinoma[J]．Clin J Gastroenterol，2017,10(3):224-228.
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