Ntawm cov kev paub nrov txog kev mob qog noj ntshav thaum ntxov, muaj qee qhov kev paub txog kab mob tsawg uas yuav tsum tau saib xyuas tshwj xeeb thiab kev kawm. Ib tug ntawm lawv yog HP-negative gastric cancer. Lub tswv yim ntawm "tsis muaj kab mob epithelial" tam sim no nrov dua. Yuav muaj kev xav sib txawv ntawm qhov teeb meem lub npe. Cov ntsiab lus kev xav no feem ntau yog raws li cov ntsiab lus hais txog cov ntawv xov xwm "Stomach and Intestine", thiab lub npe kuj siv "HP-negative gastric cancer".
Hom kab mob no muaj cov yam ntxwv ntawm qhov tsis tshua muaj tshwm sim, nyuaj rau kev txheeb xyuas, kev paub theoretical nyuaj, thiab cov txheej txheem MESDA-G yooj yim tsis siv tau. Kawm paub qhov kev paub no yuav tsum tau ntsib kev nyuaj.
1. Kev paub txog HP-negative gastric cancer
Keeb kwm
Yav dhau los, nws tau ntseeg tias ib tus neeg raug tsim txom hauv qhov tshwm sim thiab kev loj hlob ntawm kev mob qog noj ntshav yog HP tus kab mob, yog li cov qauv mob qog noj ntshav yog HP - atrophy - plab hnyuv metaplasia - qog nqaij hlav qis - mob qog nqaij hlav - mob qog noj ntshav. Cov qauv classic yeej ib txwm tau dav lees paub, lees txais thiab ntseeg ruaj khov. Cov qog loj hlob ua ke nyob rau hauv lub hauv paus ntawm atrophy thiab nyob rau hauv qhov kev txiav txim ntawm HP, yog li cov qog nqaij hlav feem ntau loj hlob nyob rau hauv atrophic plab hnyuv ib ntsuj av thiab tsis tshua muaj ib txwm tsis-atrophic gastric mucosa.
Tom qab ntawd, qee tus kws kho mob pom tau tias mob qog noj ntshav tuaj yeem tshwm sim txawm tias tsis muaj tus kab mob HP. Txawm hais tias qhov tshwm sim tsawg heev, nws yog qhov ua tau. Hom mob plab no hu ua HP-negative gastric cancer.
Nrog rau kev nkag siab me ntsis ntawm hom kab mob no, kev soj ntsuam thiab cov ntsiab lus tseem ceeb tau pib, thiab cov npe hloov tas li. Muaj ib tsab xov xwm xyoo 2012 hu ua "Gastric Cancer tom qab Sterilization", ib tsab xov xwm xyoo 2014 hu ua "HP-negative Gastric Cancer", thiab ib tsab xov xwm xyoo 2020 hu ua "Epithelial Tumors Not Infected with Hp". Kev hloov lub npe qhia txog kev nkag siab tob thiab nkag siab.
Gland Types and Growth Patterns
Muaj ob yam tseem ceeb ntawm cov qog nqaij hlav thiab cov qog pyloric hauv plab:
Cov qog nqaij hlav (cov qog oxyntic) tau muab faib rau hauv cov pob txha, lub cev, cov ces kaum, thiab lwm yam ntawm lub plab. Lawv yog linear ib leeg tubular qog. Lawv muaj cov kab mob mucous, cov hlwb tseem ceeb, cov hlwb parietal thiab endocrine hlwb, txhua tus ua lawv txoj haujlwm. Ntawm lawv, cov hlwb tseem ceeb Cov secreted PGI thiab MUC6 staining tau zoo, thiab cov parietal hlwb secreted hydrochloric acid thiab intrinsic yam;
Cov qog pyloric yog nyob rau hauv lub plab antrum cheeb tsam thiab muaj xws li mucus cells thiab endocrine hlwb. Mucus hlwb yog MUC6 zoo, thiab endocrine hlwb muaj xws li G, D hlwb thiab enterochromaffin hlwb. G hlwb secrete gastrin, D hlwb secrete somatostatin, thiab enterochromaffin hlwb secrete 5-HT.
Cov kab mob plab hnyuv ib txwm thiab cov qog hlwb tso tawm ntau yam ntawm cov qog nqaij hlav protein ntau, uas tau muab faib ua "pas plab", "plab hnyuv" thiab "sib xyaw" cov kua qaub. Kev nthuav qhia ntawm plab hnyuv thiab plab hnyuv mucins hu ua phenotype thiab tsis yog qhov chaw tshwj xeeb ntawm lub plab thiab cov hnyuv.
Muaj plaub lub xov tooj ntawm tes phenotypes ntawm cov qog nqaij hlav plab: tag nrho plab hnyuv siab raum, plab hnyuv-dominant sib xyaw, plab hnyuv-dominant tov, thiab tag nrho cov hnyuv. Cov qog uas tshwm sim los ntawm txoj hnyuv metaplasia feem ntau yog kab mob plab hnyuv sib xyaw phenotype. Cov qog nqaij hlav sib txawv feem ntau qhia cov kab mob hauv plab (MUC2+), thiab cov qog nqaij hlav nthuav dav feem ntau pom cov kab mob plab (MUC5AC+, MUC6+).
Kev txiav txim siab Hp tsis zoo yuav tsum muaj kev sib koom ua ke ntawm ntau txoj hauv kev tshawb nrhiav kom paub meej. HP-negative gastric cancer thiab post-sterilization gastric cancer yog ob lub ntsiab lus sib txawv. Yog xav paub txog X-ray tshwm sim ntawm HP-negative gastric cancer, thov mus saib hauv seem uas muaj feem ntawm "Stomach and Intestine" magazine.
2. Endoscopic manifestations ntawm HP-negative gastric cancer
Kev kuaj mob endoscopic yog tsom rau HP-negative gastric cancer. Nws feem ntau suav nrog cov qog nqaij hlav qog nqaij hlav cancer, cov qog nqaij hlav qog nqaij hlav qog nqaij hlav hauv plab, plab adenoma, raspberry foveolar epithelial qog, kos npe lub nplhaib cell carcinoma, thiab lwm yam. Kab lus no tsom mus rau endoscopic manifestations ntawm HP-negative gastric cancer.
1) Fundic gland type gastric gastric
- Dawb tsa qhov txhab
fundic gland type gastric mob plab
◆ Case 1: Dawb, tsa qhov txhab
Nqe lus piav qhia:Gastric fundic fornix-ntau curvature ntawm cardia, 10 hli, dawb, O-lia hom (SMT-zoo li), tsis muaj atrophy los yog plab hnyuv metaplasia nyob rau hauv keeb kwm yav dhau. Arbor zoo li cov hlab ntsha tuaj yeem pom ntawm qhov chaw (NBI thiab loj me ntsis)
Kev kuaj mob (ua ke nrog pathology):U, O-1la, 9mm, fundic gland type gastric cancer, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
- Cov kab mob dawb paug
fundic gland type gastric mob plab
◆ Case 2: Cov kab mob dawb, tiaj / nyuaj siab
Nqe lus piav qhia:Cov phab ntsa sab nrauv ntawm lub plab hnyuv fornix-cardia ntau dua curvature, 14 hli, dawb, hom 0-1lc, tsis muaj atrophy lossis plab hnyuv metaplasia nyob rau hauv keeb kwm yav dhau, tsis meej ciam teb, thiab cov hlab ntsha dendritic pom ntawm qhov chaw. (NBI thiab amplification abbreviated)
Kev kuaj mob (ua ke nrog pathology):U, 0-Ilc, 14mm, fundic gland type gastric cancer, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
- Liab tsa qhov txhab
fundic gland type gastric mob plab
◆ Case 3: Liab thiab tsa qhov txhab
Nqe lus piav qhia:Lub phab ntsa sab hauv ntawm qhov curvature ntawm cardia yog 12 hli, pom tseeb liab, hom 0-1, tsis muaj atrophy lossis plab hnyuv metaplasia nyob rau hauv keeb kwm yav dhau, ntshiab ciam teb, thiab cov hlab ntsha dendritic rau saum npoo (NBI thiab o me ntsis)
Kev kuaj mob (ua ke nrog pathology):U, 0-1, 12mm, fundic gland type gastric cancer, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
- Liab, tiaj tus, kev nyuaj siab lesions
fundic gland type gastric mob plab
◆ Case 4: Liab, tiaj / mob siab
Nqe lus piav qhia:Posterior phab ntsa ntawm qhov curvature ntau dua ntawm sab sauv ntawm lub plab, 18 hli, lub teeb liab, O-1Ic hom, tsis muaj atrophy los yog plab hnyuv metaplasia nyob rau hauv keeb kwm yav dhau, tsis meej ciam teb, tsis muaj dendritic cov hlab ntsha ntawm qhov chaw, (NBI thiab omissions. )
Kev kuaj mob (ua ke nrog pathology):U, O-1lc, 19mm, fundic gland type gastric cancer, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
sib tham
Cov txiv neej uas muaj tus kab mob no laus dua cov poj niam, nrog rau qhov nruab nrab hnub nyoog yog 67.7 xyoo. Vim yog cov yam ntxwv ntawm ib txhij thiab heterochrony, cov neeg mob uas kuaj pom muaj mob qog nqaij hlav hauv plab yuav tsum tau tshuaj xyuas ib xyoos ib zaug. Qhov chaw tshaj plaws yog thaj tsam ntawm cov qog nqaij hlav hauv nruab nrab thiab sab sauv ntawm lub plab (feem ntau thiab nruab nrab thiab sab sauv ntawm lub plab). Dawb SMT-zoo li tsa qhov txhab muaj ntau dua nyob rau hauv lub teeb dawb. Cov kev kho mob tseem ceeb yog kuaj EMR/ESD.
Tsis muaj lymphatic metastasis lossis vascular ntxeem tau tau pom txog tam sim no. Tom qab kev kho mob, nws yog ib qho tsim nyog los txiav txim siab seb puas yuav ua qhov kev phais ntxiv thiab ntsuas kev sib raug zoo ntawm tus kab mob malignant thiab HP. Tsis yog tag nrho cov qog nqaij hlav qog nqaij hlav plab yog HP tsis zoo.
1) Fundic gland mucosal gastric gastric
Fundic gland mucosal gastric mob plab
◆ Case 1
Nqe lus piav qhia:Cov kab mob yog me ntsis tsa, thiab RAC uas tsis yog-atrophic gastric mucosa tuaj yeem pom nyob ib puag ncig nws. Kev hloov pauv sai sai ntawm microstructure thiab microvessels tuaj yeem pom nyob rau hauv qhov tsa ntawm ME-NBI, thiab DL tuaj yeem pom.
Kev kuaj mob (ua ke nrog pathology):Fundic gland mucosal gastric gastric, U zone, 0-1la, 47 * 32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Fundic gland mucosal gastric mob plab
◆ Case 2
Kev piav qhia: Ib qho chaw tiaj tus ntawm cov phab ntsa sab nrauv ntawm qhov qis qis ntawm lub cardia, nrog kev sib xyaw xim thiab liab, cov hlab ntsha dendritic tuaj yeem pom ntawm qhov chaw, thiab qhov txhab tau nce me ntsis.
Kev kuaj mob (ua ke nrog pathology): Fundic gland mucosal gastric gastric, 0-lla, pT1a/M, ULO, LyOV0, HM0, VMO
sib tham
Lub npe ntawm "gastric gland mucosal adenocarcinoma" yog ib qho nyuaj rau hais, thiab qhov tshwm sim tsawg heev. Nws yuav tsum tau siv zog ntau dua los paub thiab nkag siab nws. Fundic gland mucosal adenocarcinoma muaj cov yam ntxwv ntawm malignancy siab.
Muaj plaub yam tseem ceeb ntawm lub teeb dawb endoscopy: ① homochromatic-fading lesions; ② subepithelial qog SMT; ③ dilated dendritic hlab ntsha; ④ cheeb tsam microparticles. ME kev ua tau zoo: DL(+) IMVP(+) IMSP(+) MCE widens IP thiab nce. Siv cov txheej txheem MESDA-G pom zoo, 90% ntawm cov qog nqaij hlav qog nqaij hlav plab ua tau raws li cov txheej txheem kuaj mob.
3) Gastric adenoma (pyloric gland adenoma PGA)
plab adenoma
◆ Case 1
Nqe lus piav qhia:Ib tug dawb tiaj tiaj tsa qhov txhab tau pom nyob rau hauv lub posterior phab ntsa ntawm gastric fornix nrog tsis meej ciam teb. Indigo carmine staining pom tsis muaj ciam teb meej, thiab LST-G-zoo li cov hnyuv loj tau pom (loj me ntsis).
Kev kuaj mob (ua ke nrog pathology):low atypia carcinoma, O-1la, 47 * 32mm, well-differentiated tubular adenocarcinoma, pT1a/M, ULO, Ly0, VO, HMO, VMO
plab adenoma
◆ Case 2
Kev piav qhia: Ib qho mob loj nrog cov nodules ntawm phab ntsa anterior ntawm nruab nrab ntawm lub plab zom mov. Active gastritis tuaj yeem pom hauv keeb kwm yav dhau. Indigo carmine tuaj yeem pom raws li ciam teb. (NBI thiab magnification me ntsis)
Pathology: MUC5AC kev qhia tau pom nyob rau hauv lub epithelium superficial, thiab MUC6 qhia tau pom nyob rau hauv lub superficial epithelium. Qhov kev kuaj mob zaum kawg yog PGA.
sib tham
Gastric adenomas yog qhov tseem ceeb mucinous qog nkag mus rau stroma thiab npog los ntawm foveolar epithelium. Vim qhov kev loj hlob ntawm glandular protrusions, uas yog hemispherical los yog nodular, gastric adenomas pom nrog endoscopic dawb lub teeb yog tag nrho cov nodular thiab protruding. Nws yog ib qho tsim nyog yuav tsum tau xyuam xim rau 4 qhov kev faib tawm ntawm Jiu Ming nyob rau hauv kev tshuaj xyuas endoscopic. ME-NBI tuaj yeem soj ntsuam tus yam ntxwv papillary / villous zoo li PGA. PGA tsis yog HP tsis zoo thiab tsis yog atrophic, thiab muaj qee yam kev pheej hmoo ntawm kev mob qog noj ntshav. Kev kuaj mob ntxov thiab kev kho mob ntxov tau tawm tswv yim, thiab tom qab kev tshawb pom, kev ua haujlwm hauv bloc resection thiab kev tshawb fawb ntxiv tau pom zoo.
4) (zoo li raspberry) foveolar epithelial gastric mob cancer
Raspberry foveolar epithelial mob qog noj ntshav
◆ Case 2
Nqe lus piav qhia:(tso tseg)
Kev kuaj mob (ua ke nrog pathology): foveolar epithelial gastric mob plab
Raspberry foveolar epithelial mob qog noj ntshav
◆ Case 3
Nqe lus piav qhia:(tso tseg)
Kev kuaj mob (ua ke nrog pathology):foveolar epithelial mob qog noj ntshav
sib tham
Raspberry, hu ua "Tuobai'er" nyob rau hauv peb lub zos, yog ib tug qus txiv hmab txiv ntoo ntawm txoj kev thaum peb tseem me nyuam yaus. Glandular epithelium thiab qog yog txuas nrog, tab sis lawv tsis yog tib cov ntsiab lus. Nws yog ib qho tsim nyog kom nkag siab txog kev loj hlob thiab kev loj hlob ntawm cov kab mob epithelial. Raspberry epithelial gastric mob cancer zoo ib yam li gastric polyps thiab tuaj yeem ua yuam kev rau gastric polyps. Lub ntsiab feature ntawm foveolar epithelium yog lub ntsiab lus ntawm MUC5AC. Yog li foveolar epithelial carcinoma yog lo lus dav dav rau hom no. Nws tuaj yeem muaj nyob hauv HP tsis zoo, zoo, lossis tom qab ua kom tsis muaj menyuam. Endoscopic tsos: round ci liab strawberry zoo li bulge, feem ntau nrog meej ciam teb.
5) Kos npe nplhaib cell carcinoma
Signet nplhaib cell carcinoma: dawb lub teeb tsos
Signet nplhaib cell carcinoma: dawb lub teeb tsos
signet nplhaib cell carcinoma
◆ Case 1
Nqe lus piav qhia:Cov kab mob tiaj tus ntawm phab ntsa tom qab ntawm lub plab vestibule, 10 hli, faded, hom O-1Ib, tsis muaj atrophy nyob rau hauv keeb kwm yav dhau, pom ciam teb thaum xub thawj, tsis pom tseeb ciam teb ntawm kev rov kuaj xyuas, ME-NBI: tsuas yog cov interfoveal ib feem ua dawb, IMVP (-) IMSP (-)
Kev kuaj mob (ua ke nrog pathology):Cov qauv ESD yog siv los kuaj xyuas lub nplhaib ntawm tes ntawm tes.
Pathological manifestations
Signet nplhaib cell carcinoma yog hom malignant tshaj plaws. Raws li kev faib tawm Lauren, gastric signet ring cell carcinoma yog cais raws li hom mob qog noj ntshav thiab yog hom kab mob uas tsis txawv txav. Nws feem ntau tshwm sim nyob rau hauv lub cev ntawm lub plab, thiab ntau dua nyob rau hauv lub tiaj thiab sunken lesions nrog discolored tones. Cov kab mob uas tau tshwm sim kuj tsis tshua muaj thiab tuaj yeem tshwm sim raws li kev yaig los yog rwj. Nws yog ib qho nyuaj rau kev kuaj xyuas thaum kuaj endoscopic nyob rau theem pib. Kev kho mob tuaj yeem yog kev kho mob xws li endoscopic ESD, nrog rau kev soj ntsuam xyuas tom qab thiab kev soj ntsuam xyuas seb puas yuav ua kev phais ntxiv. Tsis yog-curative resection yuav tsum tau phais ntxiv, thiab txoj kev phais yog txiav txim los ntawm tus kws phais.
Cov ntawv nyeem thiab cov duab saum toj no yog los ntawm "Stomach and Intestine"
Tsis tas li ntawd, kev saib xyuas yuav tsum tau them nyiaj rau esophagogastric junction cancer, cardia cancer, thiab zoo-differentiated adenocarcinoma pom nyob rau hauv HP-tsis zoo keeb kwm yav dhau.
3. Cov ntsiab lus
Hnub no kuv tau kawm txog cov kev paub txog thiab endoscopic manifestations ntawm HP-negative gastric cancer. Nws feem ntau suav nrog: kab mob qog nqaij hlav qog nqaij hlav, mob qog nqaij hlav qog nqaij hlav hauv plab, plab adenoma, (zoo li raspberry-zoo li) foveolar epithelial qog thiab kos npe nplhaib cell carcinoma.
Qhov chaw kho mob ntawm HP-tsis zoo mob qog noj ntshav yog tsawg, nws nyuaj rau kev txiav txim, thiab nws yooj yim rau kev kuaj mob. Dab tsi yog qhov nyuaj tshaj yog qhov endoscopic manifestations ntawm complex thiab tsis tshua muaj kab mob. Nws kuj tseem yuav tsum tau nkag siab los ntawm qhov kev pom endoscopic, tshwj xeeb tshaj yog cov kev paub theoretical tom qab nws.
Yog tias koj saib ntawm lub plab polyps, erosions, thiab thaj chaw liab thiab dawb, koj yuav tsum xav txog qhov muaj peev xwm ntawm Hp-negative gastric cancer. Qhov kev txiav txim siab ntawm HP tsis zoo yuav tsum ua raws li cov qauv, thiab yuav tsum tau them nyiaj rau qhov tsis zoo uas tshwm sim los ntawm kev cia siab dhau ntawm kev ntsuas ua pa. Cov kws paub endoscopists ntseeg lawv lub qhov muag ntau dua. Tau ntsib cov ncauj lus ntxaws ntxaws tom qab HP-tsis zoo mob qog noj ntshav, peb yuav tsum kawm ntxiv, nkag siab thiab xyaum ua kom paub nws.
Peb, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., yog cov chaw tsim khoom hauv Suav teb tshwj xeeb hauv cov khoom siv endoscopic, xws libiopsy forceps, hemoclip, polyp nuv, koob sclerotherapy, tshuaj tsuag catheter, cytology txhuam,phau ntawv qhia,pob zeb retrieval pob tawb, qhov ntswg biliary kua catheter thiab lwm yam. uas yog dav siv nyob rau hauvEMR,ESD,ERCP.Peb cov khoom muaj ntawv pov thawj CE, thiab peb cov nroj tsuag tau ntawv pov thawj ISO. Peb cov khoom tau raug xa tawm mus rau Tebchaws Europe, North America, Middle East thiab ib feem ntawm Asia, thiab tau txais cov neeg siv khoom ntawm kev lees paub thiab qhuas!
Post lub sij hawm: Lub Xya hli ntuj-12-2024