细胞极性（“四线”）将胃异型增生与反应性胃病中的上皮变化区分开来。
Cell polarity (the 'four lines') distinguishes gastric dysplasia from epithelial changes in reactive gastropathy.
机构信息
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA.
出版信息
Histopathology. 2021 Feb;78(3):453-458. doi: 10.1111/his.14242. Epub 2020 Oct 14.
AIMS
Gastric dysplasia is a risk factor for synchronous and subsequent gastric carcinoma. Distinguishing gastric dysplasia from reactive changes is subject to interobserver disagreement and is a frequent reason for expert consultation. We previously used assessment of surface cell polarity (the 'four lines') as a key feature to decrease equivocal diagnoses in Barrett oesophagus. In the current study, we examined for the presence or absence of the four lines in gastric dysplasia and reactive gastropathy.
MATERIALS AND METHODS
The study includes all (n = 91) in-house biopsies with at least gastric dysplasia from the surgical pathology archives of two academic institutions during a 5-year period from 2008 to 2012. A reactive gastropathy group (n = 60) was created for comparison.
RESULTS
The dysplasia/neoplasia group was comprised of 14 biopsies of gastric foveolar-type dysplasia, 59 of intestinal-type dysplasia, 14 with dysplasia in fundic gland polyps, three pyloric gland adenomas and one oxyntic gland adenoma. Loss of surface cell polarity was seen in all 88 dysplasia cases with evaluable surface epithelium. All 57 reactive gastropathy cases with evaluable surface epithelium showed intact surface cell polarity except in focal areas directly adjacent to erosions in 17 cases, where the thin wisp of residual surface mucin could not be appreciated on haematoxylin and eosin.
CONCLUSION
Surface cell polarity (the four lines) was lost in all gastric dysplasia biopsies with evaluable surface epithelium and maintained in all biopsies of reactive gastropathy. Caution should be taken in using this feature adjacent to erosions in reactive gastropathy.
目的
胃黏膜异型增生是同步和随后发生胃癌的一个危险因素。胃黏膜异型增生与反应性改变的鉴别存在观察者间的差异，这也是专家会诊的常见原因。我们之前曾使用表面细胞极性（“四条线”）评估来减少 Barrett 食管中不确定的诊断。在当前的研究中，我们检查了胃黏膜异型增生和反应性胃病中是否存在四条线。
材料和方法
本研究包括 2008 年至 2012 年期间，两个学术机构的外科病理学档案中所有（n=91）至少有胃黏膜异型增生的内部活检。创建了一个反应性胃病组（n=60）进行比较。
结果
异型增生/肿瘤组包括 14 例胃窝型异型增生活检、59 例肠型异型增生活检、14 例胃底腺息肉异型增生、3 例幽门腺腺瘤和 1 例胃窦腺腺瘤。在可评估表面上皮的 88 例异型增生病例中，均可见表面细胞极性丧失。在可评估表面上皮的 57 例反应性胃病病例中，除 17 例直接邻近糜烂的局灶性区域外，所有病例均显示完整的表面细胞极性，在这些区域，苏木精和伊红染色不能显示残留的表面黏液的薄丝。
结论
在可评估表面上皮的所有胃黏膜异型增生活检中，表面细胞极性（四条线）均丧失，而在所有反应性胃病活检中均保持。在反应性胃病中，临近糜烂区使用该特征时应谨慎。
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