Abraham Susan C, Carney J Aidan, Ooi Akishi, Choti Michael A, Argani Pedram
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
Am J Surg Pathol. 2005 Jul;29(7):969-75. doi: 10.1097/01.pas.0000163363.86099.9f.
We describe a 54-year-old woman who had multiple gastric carcinoid tumors arising in the setting of marked hypergastrinemia associated with a lack of acid production by hypertrophic parietal cells. The serum gastrin level was 1,400 pg/mL, and investigation revealed no evidence for either of the recognized causes for hypergastrinemia-associated carcinoids, autoimmune gastritis, and Zollinger-Ellision syndrome. Partial gastrectomy was performed. Pathologic examination showed multiple intramucosal and invasive carcinoid tumors of the body and fundus in a background of marked ECL cell hyperplasia. There were no gastric or duodenal ulcerations. One perigastric lymph node was metastatically involved. The oxyntic mucosa showed marked hyperplasia and hypertrophy of the parietal cells. Some of these cells were vacuolated, and many displayed protrusions of apical cytoplasm into dilated oxyntic glands filled with inspissated eosinophilic material. Similar findings have occurred in 1 other patient, strongly indicating that the clinicopathologic alterations in the 2 cases are not random but, on the contrary, represent a very rare disorder of gastric carcinoids associated with an intrinsic acid secretion abnormality of the parietal cells.
我们描述了一名54岁女性，她患有多发性胃类癌肿瘤，这些肿瘤发生在显著高胃泌素血症的背景下，伴有肥厚性壁细胞酸分泌缺乏。血清胃泌素水平为1400 pg/mL，检查未发现高胃泌素血症相关性类癌、自身免疫性胃炎和卓艾综合征这两种公认病因的证据。患者接受了胃部分切除术。病理检查显示，在显著的肠嗜铬样（ECL）细胞增生背景下，胃体和胃底存在多个黏膜内和浸润性类癌肿瘤。无胃或十二指肠溃疡。一个胃周淋巴结有转移。泌酸黏膜显示壁细胞显著增生和肥大。其中一些细胞呈空泡状，许多细胞的顶端细胞质突出到充满浓缩嗜酸性物质的扩张泌酸腺中。另一例患者也出现了类似的发现，这强烈表明这两例患者的临床病理改变并非偶然，相反，代表了一种与壁细胞内在酸分泌异常相关的非常罕见的胃类癌疾病。
