胃底腺型肿瘤内镜黏膜下剥离术治疗的临床效果评价及病理学特点分析

Clinical effects and pathological characteristics of gastric tumors of fundic gland type treated with endoscopic submucosal dissection

摘要:

为研究胃底腺型肿瘤内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗的临床效果并分析其病理学特点，收集2018年8月—2022年6月于首都医科大附属北京朝阳医院消化内镜中心行ESD，并且术后病理提示为胃底腺型胃癌或胃泌酸腺腺瘤的7例患者临床病理资料，评估患者临床特征、手术并发症情况、术前及术后病理资料和随访相关数据。7例患者病变均位于胃底部，均完成ESD治疗，术中及术后均未出现出血、穿孔等并发症。术后病理提示肿瘤细胞均起源于黏膜深层，具有浸润性生长模式，大部分肿瘤表面覆盖有正常的小凹上皮，4例患者肿瘤细胞浸润至黏膜下层，其中1例患者黏膜下浸润深度>500 μm（550 μm）。免疫组化提示MUC‑6均呈弥漫性阳性，提示肿瘤为主细胞来源，所有病例MUC‑2、MUC‑5AC、CDX‑2、CD10、CgA表达均为阴性。患者平均随访时间为22个月，术后溃疡愈合良好，未见病变复发。说明胃底腺型肿瘤有相对独特的生物学特性，ESD是治疗胃底腺型肿瘤首选的治疗方式。另外胃底腺型肿瘤组织学特点明确，可依靠免疫组化指标与其他胃部肿瘤进行鉴别。

Abstract:

To evaluate the clinical effects and pathological characteristics of gastric tumors of fundic gland type treated with endoscopic submucosal dissection (ESD), data of 7 patients who treated by ESD and whose postoperative pathology indicated gastric adenocarcinoma of fundic gland type or gastric oxyntic gland adenoma in Endoscopic Center of Beijing Chao‑Yang Hospital of Capital Medical University from August 2018 to June 2022 were collected. The clinical characteristics, surgical complications, preoperative and postoperative pathological data and follow-up data were evaluated. The lesions of the 7 patients were all located at gastric fundus, and were treated by ESD successfully. No bleeding, perforation or other complications occurred during and after the operation. Postoperative pathology showed that tumor cells originated from deep mucosa with an invasive growth pattern. Most of tumor surfaces were covered with normal concave epithelium. Tumors infiltrated into submucosa in 4 patients, and submucosa infiltration depth was more than 500 μm (550 μm) in 1 patient. Immunohistochemistry showed that MUC-6 was diffusely positive, indicating that the tumor originated from the main cell source. The expressions of MUC-2, MUC-5AC, CDX-2, CD10, and CgA were negative in all cases. With the mean follow-up time of 21 months, the ulcer healed well after the operation, with no recurrence. Gastric tumors of fundic gland type have relatively unique biological characteristics, and ESD is the preferred treatment. In addition, the histological characteristics can be used to differentiate from other gastric tumors by immunohistochemistry.