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目的探讨河南贲门癌高发区贲门癌(GCA)发生部位与癌旁肠上皮化生(IM)的组织学和组织化学特征之间的关系。方法根据肿瘤与齿状线的关系,将770例贲门癌分成6种类型:A型:肿瘤全部位于齿状线下方;B型:肿瘤2/3位于齿状线下方;C型:肿瘤1/2位于齿状线下方;D型:肿瘤1/3位于齿状线下方;E型:肿瘤全部位于齿状线上方;F型:齿状线完全被肿瘤侵犯,难以区分肿瘤与齿状线的关系。采用阿利新兰-雪夫试剂染色法和高铁二胺-阿利新兰染色法研究295例GCA癌旁IM的组织学和组织化学特征。分析GCA发生部位与癌旁IM关系。结果GCA以A型和B型为主(94%),高于C型和D型(P<0.05),未检出E型和F型。GCA癌旁IM的检出率为39%(115/295),完全性结肠型所占比例39%(45/115),高于另外3型(χ2=36.765,P<0.05)。A、B、C三型GCA癌旁IM检出率差异无统计学意义(χ2=3.500,P>0.05)。A、B型GCA癌旁IM均以完全型为主(χ2=81.203,P<0.05;χ2=34.154,P<0.05),这两种不同部位GCA癌旁IM亚型分布无差异(χ2=4.174,P>0.05)。结论河南贲门癌高发区GCA癌旁IM以完全型为主,但与贲门癌发生部位无关,而与胃远端癌及西方Barrett食管的IM不同。
Objective To investigate the relationship between histopathological and histochemical features of gastric cardia carcinoma (GCA) and adjacent paraffin epithelial metaplasia (IM) in high incidence area of cardia cancer in Henan province. Methods According to the relationship between the tumor and the dentate line, 770 cases of cardia cancer were divided into 6 types: type A: tumors were all located below the dentate line; type B: tumor 2/3 were located below the dentate line; type C: 2 below the dentate line; D type: 1/3 of the tumor is below the dentate line; E type: all the tumors are above the dentate line; F type: the dentate line is completely encroached upon by the tumor and it is difficult to distinguish between the tumor and the dentate line relationship. The histological and histochemical characteristics of 295 adjacent non-cancerous gastric cancer samples were studied by the method of Ary-Neo-Lancet-Schiff reagent staining and high-iron-diamine-alitamycin staining. Analyze the relationship between the site of GCA and adjacent non-cancerous IM. Results GCA was mainly type A and type B (94%), higher than type C and D (P <0.05). E and F were not detected. The detection rate of GC adjacent to cancer was 39% (115/295). The percentage of complete colon was 39% (45/115), higher than the other 3 (χ2 = 36.765, P <0.05). There was no significant difference in the detection rate of IM adjacent cancer between type A, B and C GCA (χ2 = 3.500, P> 0.05). There were no significant differences in the distribution of IM adjacent non-cancerous GCA between the two sites (χ2 = 4.174, P <0.05) , P> 0.05). Conclusion The GCA noncancerous gastric mucosa in the high incidence area of cardia cancer in Henan Province is mainly of complete type, but not related to the occurrence of gastric cardia carcinoma, but different from the IM of distal gastric carcinoma and western Barrett’s esophagus.