Hou W H, Wang X Z, Shi Z Y, Li F L, Fang Z H, Sun X L, Liu Y F, Wang L N, Jin M L
Department of Pathology, Pingdingshan Medical District (former 152 Central Hospital), 989 Hospital of People's Liberation Army Joint Logistic Support Force, Pingdingshan 467099, China.
Department of Gastroenterology, Pingdingshan Medical District (former 152 Central Hospital), 989 Hospital of People's Liberation Army Joint Logistic Support Force, Pingdingshan 467099, China.
Zhonghua Bing Li Xue Za Zhi. 2022 Aug 8;51(8):701-707. doi: 10.3760/cma.j.cn112151-20211129-00866.
To investigate the clinicopathological features of early gastric cancers after Helicobacter pylori (H. pylori) eradication. The clinical data of 26 cases of gastric cancer that were diagnosed after H. pylori eradication and 45 cases without H. pylori eradication in the 989 Hospital of the Joint Logistics Support Force of the People's Liberation Army (the former 152 Hospital), Pingdingshan, China from 2013 to 2021 were collected. The histological, immunophenotypic and clinical characteristics of the two groups were compared, and discussed with review of the related literature. Among the gastric cancer patients with H. pylori eradication, there were 20 males and 6 females with a median age of 65 years (range 53 to 77 years). The cancer involved the upper part of the stomach in 12 cases, the middle part of the stomach in 4 cases, and the lower part of the stomach in 10 cases. The median diameter of the tumors was 12 mm (range 4-29 mm). According to the Paris Classification, 4 cases were 0-Ⅱa, 4 cases were 0-Ⅱb, 18 cases were 0-Ⅱc. White light endoscopy showed that the lesions were reddish to yellowish. The lesion boundary was clear in 12 cases and was unclear or gastritis-like changes in 14 cases, while the irregular microvascular structure and microsurface structure, as well as the relatively visible spinous boundary, were visible under narrow-band imaging. There were 20 cases of well-differentiated tubular adenocarcinoma, 4 cases of highly to moderately differentiated tubular adenocarcinoma, and 2 cases of well-differentiated tubular adenocarcinoma with papillary adenocarcinoma. Compared with gastric cancers without H. pylori eradication, gastric cancers diagnosed after H. pylori eradication was associated with lower nucleus-cytoplasm ratio (<50%), normal epithelial coverage on the cancer surface, mild atypical epithelial coverage on the cancer surface, elongation of non-cancerous glands in the cancer tissue and subepithelial progression of cancerous glands were higher (<0.05). The cellular immunophenotypes were gastric type in 6 cases, intestinal type in 4 cases and gastrointestinal mixed type in 16 cases. The early gastric cancers diagnosed after H. pylori eradication are more subtle clinically and mostly well-differentiated tubular adenocarcinoma. The important morphological features of gastric cancer diagnosed after H. pylori eradication are decreased cytological atypia and overlying normal epithelium or mildly atypical epithelium of the cancer. Understanding and recognizing these morphological features are helpful to make correct endoscopic and pathological diagnoses.
探讨幽门螺杆菌（H. pylori）根除后早期胃癌的临床病理特征。收集了中国人民解放军联勤保障部队第989医院（原152医院）2013年至2021年期间26例幽门螺杆菌根除后诊断为胃癌的病例及45例未根除幽门螺杆菌的胃癌病例的临床资料。比较两组的组织学、免疫表型及临床特征，并结合相关文献进行讨论。在幽门螺杆菌根除后的胃癌患者中，男性20例，女性6例，中位年龄65岁（范围53至77岁）。癌累及胃上部12例，胃中部4例，胃下部10例。肿瘤中位直径12 mm（范围4 - 29 mm）。根据巴黎分类，0-Ⅱa型4例，0-Ⅱb型4例，0-Ⅱc型18例。白光内镜下病变呈淡红色至淡黄色。病变边界清晰者12例，边界不清或呈胃炎样改变者14例，窄带成像下可见不规则微血管结构和微表面结构以及相对明显的棘状边界。高分化管状腺癌20例，高中分化管状腺癌4例，高分化管状腺癌伴乳头状腺癌2例。与未根除幽门螺杆菌的胃癌相比，幽门螺杆菌根除后诊断的胃癌细胞核质比更低（<50%）、癌表面上皮覆盖正常、癌表面上皮轻度异型、癌组织中非癌性腺管延长及癌性腺管上皮下浸润更高（<0.05）。细胞免疫表型胃型6例，肠型4例，胃肠混合型16例。幽门螺杆菌根除后诊断的早期胃癌临床症状更隐匿，多为高分化管状腺癌。幽门螺杆菌根除后诊断的胃癌重要形态学特征为细胞异型性降低及癌表面覆盖正常上皮或轻度异型上皮。了解和认识这些形态学特征有助于做出正确的内镜及病理诊断。
