胃泌酸腺肿瘤的临床、内镜及组织学特点

Clinical, Endoscopic and Histological Features of Gastric Acid Gland Tumors

摘要: 目的：探讨胃泌酸腺肿瘤的临床、内镜及病理特征，以提高对该疾病的认识、诊断及治疗水平。方法：收集2020年11月至2022年9月青岛大学附属医院收治的3例泌酸腺腺瘤和4例胃底腺型胃癌的临床病理资料，分析肿瘤内镜下表现、病理特征及免疫组织化学结果，并结合文献进行探讨。结果：7例患者年龄55~71岁，平均年龄及中位年龄均为63岁，其中女性5例，男性2例，主要因腹部不适及查体发现，均无HP感染，接受内镜下黏膜剥离术(ESD)者5例，接受内镜下黏膜切除术(EMR)者2例，1例GA-FG浸润深度达1000 um，术后存在黏膜下层增生。病灶最大直径为0.3~1.5 cm。GOGA及GA-FG均以主细胞成分为主，肿瘤表面被小凹上皮所覆盖，细胞异型性小，排列成不规则的腺管状，均未见明显核分裂象，肿瘤周围黏膜均未见HP感染、萎缩及肠化。免疫表型显示MUC6和Pepsinogen呈弥漫强阳性表达，其中2例患者H+/K+-ATPase细胞阳性，MUC5AC只在覆盖在肿瘤表面的小凹上皮中表达，肿瘤细胞未见表达，CD10、MUC2、CDX-2均为阴性，热点区域Ki-67增殖指数为1%~10%，未见P53高表达和β-catenin核阳性表达。结论：胃泌酸腺肿瘤是非常罕见且具有独特病理学特征的肿瘤，预后较好，内镜下病变切除术可基本治愈，但目前对其认识不足，容易漏诊及误诊，因此熟练掌握其内镜下特点和组织学形态对提高消化内科医师的诊断及治疗能力具有重大的意义。

Abstract: Objective: To explore the clinical, endoscopic and pathological features of gastric urinary gland tu-mours in order to improve the understanding, diagnosis and treatment of this disease. Methods: Clinicopathological data of 3 cases of urinary gland adenoma and 4 cases of gastric carcinoma of fundic gland type adenocarcinoma admitted to Affiliated Hospital of Qingdao University from No-vember 2020 to September 2022 were collected, and endoscopic manifestations of the tumours, pathological features and immunohistochemical results were analysed and discussed in conjunction with the literature. Results: Seven patients were aged 55~71 years, with a mean and median age of 63 years, including five females and two males, mainly due to abdominal discomfort and findings on physical examination, none of them had HP infection, five underwent endoscopic mucosal dissection (ESD), and two underwent endoscopic mucosal resection (EMR), and in one case, the depth of infil-tration of GA-FG was up to 1,000 um, and there existed submucosal hyperplasia after surgery. The maximum diameter of the lesion was 0.3~1.5 cm. Both GOGA and GA-FG were dominated by the principal cellular component, and the surface of the tumour was covered by a small concave epithe-lium, with small cellular isoforms arranged in irregular glandular tubular shapes, and none of them showed obvious nuclear schizophrenia, and none of the peripheral mucosae of the tumour was HP infected, atrophied or enteric. Immunophenotyping showed that MUC6 and Pepsinogen were dif-fusely and strongly positively expressed, of which two patients were positive for H+/K+-ATPase cells, MUC5AC was only expressed in the small concave epithelium covering the surface of the tumour, and the tumour cells did not express it, CD10, MUC2 and CDX-2 were negative, and the Ki-67 prolif-eration index in hotspots was between 1% and 10%, and the high expression of P53 and β-cellulose nuclear positive expression were not seen. Conclusions: Gastric urinary gland tumours are very rare tumours with unique pathological features, with good prognosis, and can be basically cured by en-doscopic resection of the lesions, but they are currently under-recognised and easily missed and misdiagnosed, so proficiency in their endoscopic features and histological morphology is of great significance in improving the diagnostic and therapeutic ability of gastroenterologists.