主细胞为主型胃泌酸腺肿瘤9例报道并文献复习

Gastric oxyntic gland tumour（chief cell predominant type）：report of 9 cases and literature review

摘要:

目的：探讨主细胞为主型胃泌酸腺肿瘤的临床病理特征。方法：收集雅安市人民医院2017年12月至2020年7月诊治的9例主细胞为主型胃泌酸腺肿瘤的临床病理资料，分析内镜特征、病理形态特征及免疫组织化学检测结果，并结合文献进行探讨。结果：9例患者中5例为女性，4例为男性，中位年龄54岁。其中胃底腺型胃癌（gastric adenocarcinoma of fundic gland type，GA-FG）6例、泌酸腺腺瘤（gastric oxyntic gland adenoma，GOGA）3例。最常见的症状是腹部隐痛（5/9）。胃镜提示胃体或胃底的浅表隆起型（8/9）或浅表平坦型病变（1/9），病灶最大直径2~6 mm。GA-FG及GOGA均以主细胞成分为主，伴有壁细胞和颈黏液细胞，细胞异型性小，排列成不规则的腺管状。GA-FG中查见肿瘤周围间隙（5/6）及肿瘤周围纤维化（1/6）。免疫表型显示主细胞表达胃蛋白酶原Ⅰ、壁细胞表达H+-K+-ATP酶、颈黏液细胞表达黏蛋白6。4例患者获得12~25个月随访，均未见复发。结论：胃的主细胞为主型泌酸腺肿瘤是罕见且具有独特病理学特征的肿瘤，预后较好。

Abstract:

Objective：To assess the clinicopathological features of gastric oxyntic gland tumour chief cell predominant type（GOGT-CCPT）. Methods：Clinicopathologic characteristics of 9 patients with GOGT-CCPT admitted to Ya’an People’s Hospital from December 2017 to July 2020 were collected in the study. The endoscopic features，pathological features and immunohistochemical results were analyzed，and the relevant literatures were discussed. Results：Among the 9 patients，5 were female and 4 were male，with a median age of 54 years，including 6 cases of gastric adenocarcinoma of fundic gland type（GA-FG） and 3 cases of gastric oxyntic gland adenoma（GOGA）. The most common symptom was abdominal pain（5/9）. Gastroscopy revealed an elevated（8/9） or flat（1/9） lesion in the gastric corpus and the gastric fundus，with a diameter of 2 to 6 mm. Clinicopathological examination showed that the tumor was mostly located in the lamina propria，and both GA-FG and GOGA were mainly composed of chief cells，but there were also scattered parietal cells and mucous neck cells，with mild atypia and arranged in irregular glandular patterns. Peritumor space（5/6） and fibrosis（1/6）could be found among GA-FG cases. Immunophenotype showed that pepsinogen Ⅰ was expressed in chief cells，H+-K+-ATPase in parietal cells and mucin 6 in cervical mucus cells. Four patients had a follow-up for 12-25 months，without any recurrence. Conclusion：GOGT-CCPT is a rare tumor with a distinct clinicopathologic features and a favorable prognosis.