胃底腺来源腺癌的临床病理学特征及基因分析

doi:10.20047/j.issn1673-7210.2023.05.26

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摘要目的探讨胃底腺来源腺癌的临床病理学特征及基因特征。方法收集2017年1月至2022年3月山东省临沂市肿瘤医院7例及山东省临沂市中医院2例胃底腺来源腺癌患者，回顾性分析其临床病理学特点，并行免疫组织化学染色及二代测序（NGS）检测。结果 8例病变表面被覆正常小凹上皮，其下见低度异型腺体增生，诊断为胃底腺型腺癌（GA-FG）；1例黏膜结构层次紊乱，肿瘤性小凹上皮及低度异型腺体混杂增生，诊断为胃底腺黏膜型腺癌（GA-FGM）。其中7例GA-FG及1例GA-FGM周围黏膜未见萎缩、肠上皮化生及幽门螺杆菌感染。免疫组织化学染色结果显示，8例GA-FG均表达黏蛋白（MUC）6、胃蛋白酶原Ⅰ、H+/K+-腺苷三磷酸酶（ATPase），MUC5AC仅在表面正常小凹上皮表达；1例GA-FGM瘤细胞表达MUC6、MUC5AC、胃蛋白酶原Ⅰ、H+/K+-ATPase。NGS检测结果显示，2例GA-FG存在GNAS错义突变，1例GA-FGM存在BRAF、TP53错义突变。结论 GA-FG是一种罕见的低度恶性肿瘤，虽常浸润黏膜下层，但大多数预后较好，而GA-FGM具有不同的临床病理学特点，预后稍差。

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	张晓红1 王玉娥2 杨静2 王烨3 刘晓江1 王志蕙1 姚少波1

关键词 ：胃底腺, 胃底腺型腺癌, 胃底腺黏膜型腺癌, GNAS突变

Abstract：Objective To investigate the clinicopathological features and genetic characteristics of gastric adenocarcinoma from the fundic gland. Methods From January 2017 to March 2022, seven cases in Linyi Tumor Hospital and two cases in Linyi Traditional Chinese Medicine Hospital of Shandong Province with adenocarcinoma from fundus gland were collected. The clinicopathological features were analyzed retrospectively, and immunohistochemical staining and next generation sequencing (NGS) were detected. Results Eight cases were diagnosed as gastric adenocarcinoma of fundus gland type (GA-FG), with the surface of the lesions covered by normal concave epithelium and low grade dysplasia below. One case was diagnosed as gastric adenocarcinoma of fundic gland mucosa type (GA-FGM) with mucosal structure disorder, neoplastic concave epithelium, and low-grade dysglandular mixed hyperplasia. No atrophy, intestinal metaplasia, and Helicobacter pylori infection were observed in the surrounding mucosa of seven GA-FG and one GA-FGM cases. Immunohistochemical staining showed that mucin (MUC) 6, pepsinogenⅠ, and H+/K+-adenosine triphosphatase (ATPase) were expressed in all the eight GA-FG cases, while MUC5AC was only expressed in normal concave epithelium. The tumor cells of one GA-FGM case expressed MUC6, MUC5AC, pepsinogenⅠand H+/K+-ATPase. The results of NGS detection showed that two GA-FG cases had GNAS missense mutations, and one GA-FGM case had BRAF and TP53 missense mutations. Conclusion GA-FG is a rare low-grade malignant tumor, which often infiltrates submucosa, but has a good prognosis in most cases, while GA-FGM has different clinicopathological characteristics and a slightly worse prognosis.

Key words： Fundic gland Gastric adenocarcinoma of fundus adenocarcinoma Gastric adenocarcinoma of gastric fundus mucosa GNAS mutation

基金资助:山东省医药卫生科技发展计划项目（202103030 190）。

通讯作者: 姚少波（1971.7-），男，副主任医师，主要从事骨肿瘤、消化道早期肿瘤、淋巴瘤等病理研究工作。

作者简介: 张晓红（1985.1-），女，硕士，主要从事消化道早期肿瘤、妇科肿瘤及乳腺肿瘤等病理研究工作。

引用本文:

张晓红1 王玉娥2 杨静2 王烨3 刘晓江1 王志蕙1 姚少波1. 胃底腺来源腺癌的临床病理学特征及基因分析[J]. 中国医药导报, 2023, 20(5): 111-115.
ZHANG Xiaohong1 WANG Yu’e2 YANG Jing2 WANG Ye3 LIU Xiaojiang1 WANG Zhihui1 YAO Shaobo1. Clinicopathological features and genetics analysis of gastric adenocarcinoma from the fundic gland. 中国医药导报, 2023, 20(5): 111-115.

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