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胃底腺(主细胞优势型)型胃肿瘤中 Wnt/β-连环蛋白信号通路的改变。

Alteration in the Wnt/β-catenin signaling pathway in gastric neoplasias of fundic gland (chief cell predominant) type.

机构信息

Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Department of Human Pathology, Juntendo University School of Medicine, 1-1-19 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.

出版信息

Hum Pathol. 2013 Nov;44(11):2438-48. doi: 10.1016/j.humpath.2013.06.002. Epub 2013 Sep 5.

Abstract

Gastric neoplasia of chief cell-predominant type (GN-CCP) has been reported as a new, rare variant of gastric tumor. GN-CCPs were defined as tumors consisting of irregular anastomosing glands of columnar cells mimicking chief cells of fundic gland with nuclear atypia and prolapse-type submucosal involvement. We comparatively evaluated clinicopathologic features between 31 GN-CCPs and 130 cases of conventional gastric adenocarcinoma invading into submucosa (CGA-SM) in addition to nuclear β-catenin immunolabeling and direct sequencing of members of the Wnt/β-catenin pathway, CTNNB1, APC, and AXIN, in a subset of these tumors. GN-CCP presented as small protruded lesions located in the upper third of the stomach, with minimal involvement into the submucosa and rare lymphovascular invasion. None of the lesions have demonstrated a recurrence of disease or metastasis on follow-up. Nuclear β-catenin immunolabeling was higher in GN-CCP (labeling index [LI]: median, 19.3%; high expresser [LI >30%], 7/27 cases [26%]) than CGA-SM (median LI, 14.7%; high expresser, 1/19 cases [6%]). Missense mutation of APC was observed in 1 GN-CCP but not CGA-SM. Missense or nonsense mutations of CTNNB1 and AXIN1 were higher in GN-CCPs (14.8%, both) than CGA-SMs (5.3%, both). Missense mutations of AXIN2 were higher in GN-CCPs (25.9%) than in CGA-SMs (10.5%). Overall, 14 (51.9%) of 27 GN-CCPs and 5 (26.3%) of 19 CGA-SM cases harbored at least 1 of these gene mutations. In conclusion, GN-CCPs as a unique variant of nonaggressive tumor are characterized by nuclear β-catenin accumulation and mutation of CTNNB1 or AXIN gene, suggesting activation of the Wnt/β-catenin pathway.

摘要

胃主细胞型肿瘤(GN-CCP)已被报道为一种新的、罕见的胃肿瘤变异型。GN-CCP 被定义为由类似于胃底腺主细胞的不规则吻合的柱状细胞组成的肿瘤,具有核异型性和黏膜下突入型累及。我们比较评估了 31 例 GN-CCP 和 130 例常规胃腺癌侵犯黏膜下层(CGA-SM)的临床病理特征,同时对这些肿瘤中的一部分进行了核 β-连环蛋白免疫标记和 Wnt/β-连环蛋白通路成员 CTNNB1、APC 和 AXIN 的直接测序。GN-CCP 表现为位于胃上部的小隆起性病变,黏膜下累及较少,很少有血管淋巴管侵犯。在随访中,没有病变显示疾病复发或转移。GN-CCP 的核 β-连环蛋白免疫标记更高(标记指数 [LI]:中位数,19.3%;高表达者 [LI>30%],7/27 例[26%]),而 CGA-SM(中位数 LI,14.7%;高表达者,1/19 例[6%])。在 1 例 GN-CCP 中观察到 APC 的错义突变,但在 CGA-SM 中未观察到。GN-CCP 中的 CTNNB1 和 AXIN1 错义或无义突变较高(分别为 14.8%,均),而 CGA-SM 较低(分别为 5.3%,均)。AXIN2 的错义突变在 GN-CCP 中较高(25.9%),在 CGA-SM 中较低(10.5%)。总体而言,27 例 GN-CCP 中有 14 例(51.9%)和 19 例 CGA-SM 中有 5 例(26.3%)至少携带 1 种这些基因突变。总之,GN-CCP 作为一种非侵袭性肿瘤的独特变异型,其特征是核 β-连环蛋白积聚和 CTNNB1 或 AXIN 基因突变,提示 Wnt/β-连环蛋白通路的激活。

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