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胃上皮内瘤变的长期随访研究:从低级别异型增生进展为浸润性癌。

Long-term follow-up study of gastric intraepithelial neoplasias: progression from low-grade dysplasia to invasive carcinoma.

作者信息

Park Soo Young, Jeon Seong Woo, Jung Min Kyu, Cho Chang Min, Tak Won Young, Kweon Young Oh, Kim Sung Kook, Choi Yong Hwan

机构信息

Department of Gastroenterology, Kyungpook National University College of Medicine, Junggu, Daegu, Korea.

出版信息

Eur J Gastroenterol Hepatol. 2008 Oct;20(10):966-70. doi: 10.1097/MEG.0b013e3283013d58.

Abstract

BACKGROUND AND STUDY AIMS

A gastric intraepithelial neoplasia (IEN) is usually regarded as a precancerous lesion; however, the natural history of the gastric IEN has not been clarified. We aimed to evaluate the progression of dysplasia in gastric IENs.

PATIENTS AND METHODS

As a retrospective study, we reviewed 26 gastric adenomas with low-grade dysplasia (LGD) and one with high-grade dysplasia (HGD) from 18 patients. The patients were followed up for a median of 66 months from 1996 to 2004 (mean 58 months, 20-112 months) in Kyungpook National University Hospital. The histological diagnosis was classified according to the Vienna classification. We reviewed clinical (age and sex), morphological (size, color, shape, location in stomach, surface nodularity, and presence of the erosion), and histological (histological diagnosis, infection with Helicobacter pylori, infiltration of inflammatory cells, atrophy, intestinal metaplasia, microscopic erosions, and glandular appearance) characteristics with regard to progression of dysplasia.

RESULTS

We found eight IENs of progressive dysplasia (29.6%). One IEN with HGD and three IENs with LGD progressed to invasive adenocarcinoma (category 5). Four gastric IENs with LGD progressed to HGD (category 4). The clinical, morphological, and histological characteristics did not reveal any distinguishable features for progressive dysplasia.

CONCLUSION

For the potential risk of progressive dysplasia, gastric IENs should be treated actively using the recently advanced therapeutic endoscopic techniques, regardless of the degrees of dysplasia.

摘要

背景与研究目的

胃上皮内瘤变(IEN)通常被视为癌前病变;然而,胃IEN的自然病程尚未明确。我们旨在评估胃IEN中发育异常的进展情况。

患者与方法

作为一项回顾性研究,我们回顾了18例患者的26个低级别发育异常(LGD)胃腺瘤和1个高级别发育异常(HGD)胃腺瘤。这些患者于1996年至2004年在庆北国立大学医院接受了中位时间为66个月的随访(平均58个月,20 - 112个月)。组织学诊断根据维也纳分类法进行分类。我们回顾了与发育异常进展相关的临床(年龄和性别)、形态学(大小、颜色、形状、胃内位置、表面结节性和糜烂的存在情况)以及组织学(组织学诊断、幽门螺杆菌感染、炎性细胞浸润、萎缩、肠化生、微观糜烂和腺体外观)特征。

结果

我们发现8个发育异常进展的IEN(29.6%)。1个HGD的IEN和3个LGD的IEN进展为浸润性腺癌(5类)。4个LGD的胃IEN进展为HGD(4类)。临床、形态学和组织学特征未显示出任何发育异常进展的可区分特征。

结论

鉴于发育异常进展的潜在风险,无论发育异常程度如何,均应使用最近先进的治疗性内镜技术积极治疗胃IEN。

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