Gastric Adenocarcinoma of Fundic Gland Type (Chief Cell Predominant Type): Proposal for a New Entity of Gastric Adenocarcinoma
Gastric Adenocarcinoma of Fundic Gland Type (Chief Cell Predominant Type): Proposal for a New Entity of Gastric Adenocarcinoma
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DOI：
10.1097/pas.0b013e3181d94d53
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发表时间：
2010-05-01
影响因子：
5.6
通讯作者：
Watanabe, Sumio
中科院分区：
文献类型：
--
作者：
Ueyama, Hiroya;Yao, Takashi;Watanabe, Sumio
胃底腺型胃腺癌仅有少数病例报告。胃腺癌伴主细胞分化（GA-CCD）是近年来报道的一种新的胃腺癌类型。然而，其临床病理特征是不确定的。为了阐明它们，本研究评价了表现胃蛋白酶原-I表达的GA-CCD（10个病变：A组）和随机选择的分化型胃腺癌（111个病变：B组）。免疫组化法检测MUC 2、MUC 5AC、MUC 6、CD 10、胃蛋白酶原-I、H+/K+-ATP酶和嗜铬粒蛋白A对细胞分化的影响，Ki-67对细胞增殖的影响以及p53蛋白的过度表达。在A组中，所有GA-CCD均位于胃的上1/3。肿瘤小，平均最大直径范围为4至20（平均，8.6）mm。组织学上，GA-CCD是分化良好的腺癌组成的浅灰蓝色，嗜碱性柱状细胞与轻度核扩张，类似主细胞。免疫组化，散在阳性H+/K+-ATP酶观察到除了胃蛋白酶原-I和MUC 6的表达，表明局灶性分化壁细胞。B组2例胃蛋白酶原-I灶性表达。由于这2例病例的临床病理和组织学特征不同，因此不能将其归类为GA-CCD。轻度增生、无淋巴管浸润、低增殖活性、无p53过表达、无复发提示GA-CCD侵袭性较低。GA-CCD是罕见的，但它有独特的临床病理特征，特别是在肿瘤的位置，组织学特征，表型表达，和低度恶性。我们提出胃底腺型（主细胞为主型）胃腺癌是胃腺癌的一个新的类型。
Only a few cases of gastric adenocarcinoma of fundic gland type have been reported. Gastric adenocarcinoma with chief cell differentiation (GA-CCD) has been recently reported as a new variant of gastric adenocarcinoma. However, its clinicopathologic features are uncertain. To elucidate them, GA-CCDs exhibiting pepsinogen-I expression (10 lesions: Group A) and randomly selected gastric adenocarcinomas of differentiated type (111 lesions: Group B) were evaluated in this study. Cell differentiation by MUC2, MUC5AC, MUC6, CD10, pepsinogen-I, H+/K+-ATPase and chromogranin A, cell proliferation by Ki-67, and overexpression of p53 protein were evaluated immunohistochemically. In Group A, all GA-CCDs were located in the upper third of the stomach. Tumors were small, with the average maximum diameter ranging from 4 to 20 (average, 8.6) mm. Histologically, GA-CCDs were well-differentiated adenocarcinomas composed of pale gray-blue, basophilic columnar cells with mild nuclear atypia, resembling chief cells. Immunohistochemically, scattered positivity for H+/K+-ATPase was observed in addition to expression of pepsinogen-I and MUC6, indicating focal differentiation toward parietal cells. In Group B, pepsinogen-I was very focally expressed in 2 cases. As these 2 cases exhibited different clinicopathological and histologic features, they cannot be categorized as GA-CCD. Mild atypism, no lymphovascular invasion, low proliferative activity, no overexpression of p53, and no recurrence indicated less aggressiveness of GA-CCD. GA-CCD is rare, but it has distinct clinicopathological characteristics, especially in terms of tumor location, histologic features, phenotypic expression, and low-grade malignancy. We propose gastric adenocarcinoma of fundic gland type (chief cell predominant type) as a new entity of gastric adenocarcinoma.