Isozaki H, Okajima K, Hu X, Fujii K, Sako S
Department of Surgery, Osaka Medical College, Japan.
Cancer. 1996 Nov 15;78(10):2078-86.
Multiple early gastric carcinomas were found in 5-15% of patients with early gastric carcinoma. The goals of this study were to clarify the clinicopathologic features of multiple early gastric carcinomas and to investigate their histogenesis.
Of 724 patients with early gastric carcinoma, there were 65 with multiple (159) gastric carcinomas. Investigation of the histogenesis of multiple gastric carcinomas was conducted using serial sections of the stomach of 33 patients with multiple early gastric carcinomas (MEGC) and 33 patients with solitary early gastric carcinoma (SEGC). The cancerous and epithelial dysplastic lesions were examined by hematoxylin and eosin staining and immunohistochemical staining of p53 protein with anti-p53 monoclonal antibody (BP53-12).
The macroscopically depressed type was common. The flat type was observed only in accessory lesions, most of which were diagnosed postoperatively. There were 126 differentiated type lesions, and 33 poorly differentiated type lesions. In most cases both the main and accessory lesions were differentiated. The average number of epithelial dysplastic lesions (18.3) in the stomach of patients with differentiated MEGC was significantly higher than that in the stomach of patients with differentiated SEGC (7), poorly differentiated MEGC (2.1), and SEGC (2). Moreover, severe dysplastic lesions were frequently observed in the stomach of patients with differentiated MEGC. p53 protein expression was detected in 0.9% of mildly atypical epithelial dysplastic lesions, 3.7% of moderately atypical dysplastic lesions, and 18.2% of severely dysplastic lesions.
In cases of early gastric carcinoma, small depressed type and flat type accessory lesions of multiple gastric carcinomas should be detected preoperatively. Epithelial dysplastic lesions probably are significant in the histogenesis of differentiated multiple gastric carcinomas.
在早期胃癌患者中，5% - 15%的患者存在多发早期胃癌。本研究的目的是阐明多发早期胃癌的临床病理特征并探究其组织发生机制。
在724例早期胃癌患者中，有65例患有多发（159处）胃癌。对33例多发早期胃癌（MEGC）患者和33例单发早期胃癌（SEGC）患者的胃连续切片进行多发胃癌组织发生机制的研究。通过苏木精 - 伊红染色以及用抗p53单克隆抗体（BP53 - 12）进行p53蛋白免疫组化染色来检查癌性和上皮发育异常病变。
宏观上凹陷型较为常见。扁平型仅在附属病变中观察到，其中大多数在术后才得以诊断。有126处分化型病变和33处低分化型病变。在大多数情况下，主要病变和附属病变均为分化型。分化型MEGC患者胃内上皮发育异常病变的平均数量（18.3）显著高于分化型SEGC患者胃内（7）、低分化型MEGC患者胃内（2.1）以及SEGC患者胃内（2）的上皮发育异常病变平均数量。此外，在分化型MEGC患者的胃中经常观察到严重发育异常病变。在轻度非典型上皮发育异常病变中，p53蛋白表达检测率为0.9%，中度非典型发育异常病变中为3.7%，严重发育异常病变中为18.2%。
在早期胃癌病例中，术前应检测多发胃癌的小凹陷型和扁平型附属病变。上皮发育异常病变可能在分化型多发胃癌的组织发生中具有重要意义。
