胃增生性息肉伴异型增生/腺癌的临床病理学特征分析

doi:10.3969/j.issn.1006-7795.2025.04.012

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (4): 663-669.doi: 10.3969/j.issn.1006-7795.2025.04.012

胃增生性息肉伴异型增生/腺癌的临床病理学特征分析

徐瑞¹,高杨¹,岳冰¹,张政²,杜风²,陈光勇^1*,李鹏^2*

1.首都医科大学附属北京友谊医院病理科，北京 100050；2.首都医科大学附属北京友谊医院消化科国家消化系统疾病临床医学研究中心，北京 100050

收稿日期:2025-04-01 出版日期:2025-08-21 发布日期:2025-08-29
通讯作者: 陈光勇,李鹏 E-mail:chenguangyong@ ccmu. edu. cn;lipeng@ ccmu. edu. cn
基金资助:
国家自然科学基金面上项目（82270591），国家重点研发计划项目（2023YFC2507406），研究型病房卓越临床研究计划项目（BRWEP2024W162020100，BRWEP2024W162020114），北京市医院管理中心“登峰”人才计划项目（ DFL20220101）。

Clinicopathologic features of gastric hyperplastic polyps with dysplasia/adenocarcinoma

Xu Rui¹, Gao Yang¹, Yue Bing¹, Zhang Zheng², Du Feng², Chen Guangyong^1*，Li Peng^2*

1.Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China；2.Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, Beijing 100050, China

Received:2025-04-01 Online:2025-08-21 Published:2025-08-29
Supported by:
This study was supported by National Natural Science Foundation of China（82270591），National Key Research and Development Program of China（2023YFC2507406），The Outstanding Clinical Research Program of Research Ward ( BRWEP2024W162020100，BRWEP2024W162020114)，Beijing Hospitals Authority “Dengfeng” Talent Training Plan（DFL20220101）.

摘要/Abstract

摘要： 目的探讨胃增生性息肉伴异型增生/腺癌的临床、组织病理学特征及免疫组织化学表达情况，提高对该病的诊断水平。方法回顾性分析2020年1月至2024年12月期间首都医科大学附属北京友谊医院病理科诊断的24例胃增生性息肉伴异型增生/腺癌的病例 (共44枚息肉)，分析其临床、病理及随访资料。结果女性20例、男性4例，平均年龄（65.5±7.9）（56~76）岁。44枚息肉中3枚发生于胃窦、1枚发生于胃角、40枚发生于胃底/体部。32枚息肉诊断为高级别异型增生、4枚诊断为低级别异型增生、4枚为低级别+高级别异型增生共存、2枚以黏液腺癌为主、1枚为低分化腺癌、1枚以印戒细胞癌为主。背景黏膜23例符合自身免疫性化生性萎缩性胃炎的组织学表现。8枚息肉P53为突变型表达模式。通过MUC5/MUC6/MUC2/CD10联检，33枚息肉黏液表现为胃型（其中25枚为小凹上皮型），4枚为肠型，5枚为胃肠混合型，2枚为非胃非肠型。结论胃增生性息肉肿瘤性转化与自身免疫性化生性萎缩性胃炎密切相关，需重视对背景黏膜的评估，尽量做到早发现、早诊断和早治疗。

关键词: 胃增生性息肉, 异型增生, 腺癌, 自身免疫性化生性萎缩性胃炎, 内镜下黏膜剥离术, 免疫表型

Abstract: Objective To investigate the cIinicopathological features and immunohistochemical expression of gastric hyperplastic polyps（GHPs）with dysplasia/adenocarcinoma. Methods A retrospective analysis of 24 cases(44 polyps) that were diagnosed as GHPs with dysplasia/adenocarcinoma in our hospital from January 2020 to December 2024 was reviewed，and clinical, histomorphological, immunophenotypic and follow-up data were analyzed．Results There were 20 female and 4 male cases, with a mean age of （65.5±7.9） (range 56~76 )years. Among 44 polyps, 3 occurred in the antrum of the stomach, 1 in the gastric horn, and 40 in the fundus/body. Among the polyps, 32 cases were diagnosed as high-grade dysplasia, 4 cases as low-grade dysplasia, 4 cases as coexistence of low-grade + high-grade dysplasia, 2 cases as mucinous adenocarcinoma, 1 cases as poorly differentiated adenocarcinoma, and 1 cases as signet-ring cell carcinoma. The histological manifestations of 23 cases of background mucosa were autoimmune metaplastic atrophic gastritis(AMAG). the P53 of 8 polyps showed a mutant expression pattern. Through MUC5/MUC6/MUC2/CD10 joint examination, 33 cases showed gastric type (25 cases of which were foveal epithelium type), 4 cases were intestinal type, 5 cases were mixed gastrointestinal type, and 2 cases were non-gastrointestinal type. Conclusion The neoplastic transformation of GHPs is closely related to AMAG. It is necessary for clinicians and pathologists to strengthen their evaluation of background mucosa, to achieve early detection，early diagnosis and early treatment.

Key words: gastric hyperplastic polyps, dysplasia, adenocarcinoma, autoimmune metaplastic atrophic gastritis, endoscopic submucosal dissection, immunophenotype

中图分类号:

R361
R573

徐瑞, 高杨, 岳冰, 张政, 杜风, 陈光勇, 李鹏. 胃增生性息肉伴异型增生/腺癌的临床病理学特征分析[J]. 首都医科大学学报, 2025, 46(4): 663-669.

Xu Rui, Gao Yang, Yue Bing, Zhang Zheng, Du Feng, Chen Guangyong, Li Peng. Clinicopathologic features of gastric hyperplastic polyps with dysplasia/adenocarcinoma[J]. Journal of Capital Medical University, 2025, 46(4): 663-669.

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胃增生性息肉伴异型增生/腺癌的临床病理学特征分析

Clinicopathologic features of gastric hyperplastic polyps with dysplasia/adenocarcinoma

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