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目的探讨胃黏膜活检组织中腺瘤的临床病理学特点、免疫表型、生物学行为。方法应用光学显微镜、免疫组织化学和随访的方法对52例胃黏膜活检病理诊断腺瘤的标本进行研究。结果胃腺瘤的病理组织学特点:核间变,表现为核的体积增大及形态不规则,并出现1或多个核仁,核分裂≤2/10HPF。腺体结构变化:腺瘤的腺管多比较一致,偶有腺体的大小及轮廓不规则,可伴有肠上皮化生。当核体积增大明显,核分裂>2/10HPF,腺体出现不规则的扭曲、分枝状结构,提示腺瘤有发展。免疫表型:不同分子量角蛋白和肿瘤相关糖类抗原均有较高的阳性表达。CDX-2、APC、PTEN和CEA高表达与腺瘤的形成密切相关。黏蛋白Muc-2高表达与黏蛋白Muc-1低表达呈负相关,两种结合有助于判断胃腺瘤的进展情况。survivin、bcl-2和p53蛋白的阳性表达率低,三者结合对胃腺瘤的恶性转化的判别有重要意义。Ki-67阳性细胞数在20%~40%之间,可作为细胞增殖程度,评价预后的有用指标。37~45月随访结果发现,治愈42.3%(22/52)、仍有腺瘤样增生38.5%(20/52)、有发展显示异型增生15.4%(8/52)、发展为黏膜内癌者3.8%(2/52)。结论胃腺瘤出现核体积明显增大,核分裂>2/10HPF,腺体不规则的扭曲、分枝状结构;免疫组织化学染色显示survivin、bcl-2、PTEN、p53蛋白阳性表达增强,细胞增殖指数Ki-67>40%,提示有癌变倾向,应内镜下黏膜切除。
Objective To investigate the clinicopathological characteristics, immunophenotype and biological behavior of adenoma in gastric mucosa biopsy. Methods The pathological diagnosis of adenomas in 52 cases of gastric mucosa biopsy was studied by light microscopy, immunohistochemistry and follow-up. Results Histopathological features of gastric adenomas: nuclear intercalation, manifested as nuclear enlargement and irregular morphology, and one or more nucleoli, nuclear fission ≤ 2/10 HPF. Changes in glandular structure: The glandular ducts of adenomas are relatively uniform, occasionally the size and contours of the glands are irregular and may be accompanied by intestinal metaplasia. When the nuclear volume increased significantly, nuclear fission> 2/10 HPF, the gland appeared irregular twisted, branched-like structure, suggesting the development of adenomas. Immunophenotype: High molecular weight keratin and tumor-associated carbohydrate antigens have high positive expression. The high expression of CDX-2, APC, PTEN and CEA is closely related to the formation of adenomas. The high expression of mucin Muc-2 was negatively correlated with the low expression of Mucin-1, and the two combinations were helpful in judging the progress of gastric adenoma. The positive expression rate of survivin, bcl-2, and p53 protein is low, and the combination of the three has important significance in distinguishing the malignant transformation of gastric adenoma. The number of Ki-67 positive cells is between 20% and 40%, which can be used as a useful indicator of cell proliferation and evaluation of prognosis. Follow-up results from the 37th to 45th months showed that 42.3% (22/52) of the patients were cured, 38.5% (20/52) of adenomatous hyperplasias were still present, 15.4% (8/52) of dysplasias developed, and developed into intramucosal cancer. 3.8% (2/52). Conclusion The appearance of nuclear enlargement in gastric adenomas is significantly increased. The nuclear fission is more than 2/10 HPF. The gland is irregularly distorted and has a branched structure. Immunohistochemical staining shows that the positive expression of survivin, bcl-2, PTEN, and p53 protein is enhanced and the cell proliferation index is increased. Ki-67> 40%, suggesting a tendency to cancer, mucosal resection should be endoscopic.