Twelve-year natural history of a gastric adenocarcinoma of fundic gland type.
Twelve-year natural history of a gastric adenocarcinoma of fundic gland type.
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DOI：
10.1007/s12328-016-0680-5
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发表时间：
2016-12
影响因子：
1
通讯作者：
Itoh, Fumio
中科院分区：
文献类型：
--
作者：
Sato, Yoshinori;Fujino, Takashi;Kasagawa, Akira;Morita, Ryo;Ozawa, Shun-Ichiro;Matsuo, Yasumasa;Maehata, Tadateru;Yasuda, Hiroshi;Takagi, Masayuki;Itoh, Fumio
一位77岁的女性接受了上胃肠道（UGI）内镜筛查检查，在穹窿后壁发现了一个10毫米的红色粘膜下肿瘤样病变。进行了活检，但没有恶性肿瘤的证据，因此决定每年进行UGI内镜随访。12年后，另一个活检标本的检查显示为基底腺型腺癌。在长时间的随访中，病变的大小和形状没有明显的变化。内镜下粘膜剥离术（ESD），实现整体切除。组织病理学表现为11 × 10 mm的扁平升高病灶。它由形状不规则的腺体组成，侵入粘膜下层达300µm。免疫组化检查包括胃蛋白酶原I、MIST-1、MUC6和H+/K+- atp酶特异性抗体，证实不规则形状腺体的基底腺分化，Ki-67标记指数很低。因此，诊断为基底腺型胃腺癌。自发生ESD至今已有四年，并无复发。据我们所知，这是关于GAFG长期自然历史的第一份报告。12年未见形态学改变；肿瘤仍在粘膜下层内。我们在这个病例中的观察结果加强了GAFG是一种特殊类型的低级别恶性胃腺癌的概念。
A 77-year-old woman underwent an upper gastrointestinal (UGI) endoscopy screening examination, and a 10-mm reddish, submucosal tumor-like lesion was found on the posterior wall of the fornix. Biopsy was performed, but there was no evidence of malignancy, so annual follow-up by UGI endoscopy was decided upon. After 12 years, examination of another biopsy specimen revealed an adenocarcinoma of the fundic gland type. There had been no significant change in the size or shape of the lesion over the long follow-up period. Endoscopic submucosal dissection (ESD) was performed, and en bloc resection was achieved. Histopathologically, the tumor appeared as a flat elevated lesion measuring 11 × 10 mm. It was composed of irregularly shaped glands and invaded the submucosa up to 300 µm. Immunohistochemical examination involving specific antibodies to pepsinogen I, MIST-1, MUC6, and H+/K+-ATPase confirmed the fundic gland differentiation of the irregularly shaped glands together with a very low Ki-67 labeling index. Thus, gastric adenocarcinoma of the fundic gland type (GAFG) was diagnosed. Four years have passed since the ESD, and there has been no recurrence. To the best of our knowledge, this is the first report of the long-term natural history of GAFG. Over the 12 years, no morphologic changes were observed; the tumor remained within the submucosal layer. Our observations in this case strengthen the notion that GAFG is a specific type of gastric adenocarcinoma of low-grade malignancy.