Clinicopathological features of gastric adenocarcinoma of the fundic gland (chief cell predominant type) by retrospective and prospective analyses of endoscopic findings
Clinicopathological features of gastric adenocarcinoma of the fundic gland (chief cell predominant type) by retrospective and prospective analyses of endoscopic findings
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DOI：
10.1111/den.12676
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发表时间：
2016-11-01
影响因子：
5.3
通讯作者：
Shibuya, Daisuke
中科院分区：
文献类型：
--
作者：
Chiba, Takashi;Kato, Katsuaki;Shibuya, Daisuke
背景与目的：胃底腺型（主细胞为主型）胃腺癌（GA-FG-CCP）是主细胞分化型胃腺癌的一种变异型。 GA-FGCCP 很罕见，而且还没有被很好地理解。本研究旨在通过回顾性和前瞻性分析内镜检查结果来探讨GA-FG-CCP的临床病理特征。方法：共20例患者，其中9例接受内镜粘膜下剥离术（ESD）治疗，诊断为GA-FG-CCP。通过回顾性回顾过去的内镜记录和明确诊断后的随访来分析形态学变化，包括幽门螺杆菌（H. pylori）感染状况。结果：GA-FG-CCP为小而白色的病变，伴有不典型的血管生长，其宏观类型分别分为0-IIa（60％）、0-IIb（25％）和0-IIc（15％）。尽管在 75% 的病例中发现了与当前或既往幽门螺杆菌感染相关的胃粘膜萎缩，但病变发现于上部 70% 或中部 (30%) 的非萎缩性胃粘膜。在接受 ESD 治疗的 9 例患者中，80% 的切除病灶发现粘膜下浸润，但未检测到淋巴静脉浸润。 GA-FG-CCP的Ki-67标记指数较低，为3.2%，在58.9±13.1个月的长期内镜观察中，很少检测到可见的形态学变化。结论：这些数据表明，GA-FG-CCP即使很容易发生粘膜下浸润，只要它是主细胞为主的类型，没有其他上皮异常，也可能是低度恶性。此外，尽管幽门螺杆菌感染或胃粘膜萎缩，GA-FG-CCP仍可能发生。
Background and Aim: Gastric adenocarcinoma of the fundic gland type (chief cell predominant type) (GA-FG-CCP) is a variant of gastric adenocarcinoma with chief cell differentiation. GA-FGCCP is rare and not well understood. The present study aimed to investigate the clinicopathological features of GA-FG-CCP using retrospective and prospective analyses of endoscopic findings.Methods: A total of 20 patients including nine cases treatedwith endoscopic submucosal dissection (ESD) were diagnosed with GA-FG-CCP. Morphological changes were analyzed by retrospectively retracing past endoscopic records and following up after definitive diagnoses, including the status of Helicobacter pylori (H. pylori) infection.Results: GA-FG-CCP were small and whitish lesions accompanied by atypical vascular growth and theirmacroscopic types were classified as 0-IIa (60%), 0-IIb (25%), and 0-IIc (15%), respectively. The lesions were found in the non-atrophic gastric mucosa of the upper 70%) ormiddle portion (30%), although gastricmucosal atrophy associated with current or past H. pylori infection was identified in 75% of cases. In the nine cases treated with ESD, submucosal invasion was identified in 80% of the resected lesions, but no lymphovenous infiltration was detected. Ki-67 labeling index of GA-FG-CCP was low at 3.2% and visible morphological changes were rarely detected during long-term endoscopic observation for 58.9 +/- 13.1 months.Conclusions: These data indicate that GA-FG-CCP, even when submucosal invasion occurs easily, might be of low-grade malignancy as long as it is the chief cell predominant type without other epithelial abnormalities. In addition, GA-FG-CCP might develop despite H. pylori infection or gastric mucosal atrophy.