Kono Tokuyuki, Imai Yasuo, Ichihara Takao, Miyagawa Kasumi, Kanemitsu Kiyonori, Ajiki Tetsuo, Kawasaki Kentaro, Kamigaki Takashi, Ikuta Hajime, Ohbayashi Chiho, Yokozaki Hiroshi, Fujimori Takahiro, Kuroda Yoshikazu
Department of Surgical and Molecular Pathology, Dokkyo Medical University School of Medicine, Kita-kobayashi, Mibu, Shimotsuga-gun, Tochigi, Japan.
Pathol Res Pract. 2007;203(1):53-6. doi: 10.1016/j.prp.2006.08.010. Epub 2006 Nov 13.
A 54-year-old man, found to have a submucosal tumor in the stomach by double contrast roentgenography, endoscopy, and endoscopic ultrasonography, underwent a laparoscopic partial gastrectomy. The pathological examination revealed that the lesion, measuring 45 mm x 35 mm, was an inverted hyperplastic polyp (IHP) located in the submucosal layer and consisting mostly of columnar cells resembling foveolar epithelium and pyloric gland cells. Notably, adenocarcinoma with adjacent dysplasia was observed in the submucosal glands. Transition from hyperplasia to dysplasia and from dysplasia to adenocarcinoma was noted. The adenocarcinoma component was intensely and diffusely positive for p53 overexpression, while the dysplasia component showed only weak and focal positivity, suggesting a role of p53 mutation in the dysplasia-carcinoma sequence. Gastric IHP is very rare, and only 31 cases (in 29 patients) have been reported. Five of these IHPs coexisted with gastric adenocarcinomas, which had all developed separately from the IHP lesions. Therefore, this is the first case of adenocarcinoma arising within gastric IHP itself.
一名54岁男性，经双重对比X线造影、内镜检查和内镜超声检查发现胃内有一个黏膜下肿瘤，随后接受了腹腔镜部分胃切除术。病理检查显示，该病变大小为45mm×35mm，是一个位于黏膜下层的倒置增生性息肉（IHP），主要由类似于胃小凹上皮和幽门腺细胞的柱状细胞组成。值得注意的是，在黏膜下腺体中观察到伴有相邻发育异常的腺癌。注意到从增生到发育异常以及从发育异常到腺癌的转变。腺癌成分p53过度表达呈强弥漫性阳性，而发育异常成分仅呈弱局灶性阳性，提示p53突变在发育异常-癌序列中起作用。胃IHP非常罕见，仅报道过31例（29例患者）。其中5例IHP与胃腺癌共存，这些腺癌均与IHP病变分别发生。因此，这是首例发生于胃IHP本身的腺癌病例。
