摘要目的:探讨胃底腺型腺癌的临床与病理特征。方法:纳入2018年1月—2019年8月在南京鼓楼医院确诊为胃底腺型腺癌的患者共12例，其中7例患者行内镜黏膜下剥离术(endoscopic submuscal dissection，ESD)治疗。回顾患者内镜及病理资料，分析胃底腺型腺癌的病灶特征，并对这些患者进行随访。结果:胃底腺型腺癌患者临床症状无特异性，且均无幽门螺杆菌感染，10例位于胃上1/3，2例位于胃中1/3。内镜下观察病灶，最主要的特征是病灶褪色(9例)，病灶均≤1 cm；内镜下肉眼分型，2例为0-Ⅰ型，9例为0-Ⅱa型，1例为0-Ⅱc型；病灶界限均清晰，病灶表面可见有分支的扩张血管。7例行ESD治疗的患者中5例有黏膜下浸润。免疫组化结果：9例为主细胞型，3例为混合型；11例MUC6阳性，4例MUC5AC阳性，2例MUC2阳性，3例CD10阳性；12例患者均有P53阳性，但9例Ki-67阳性<10%。12例患者平均随访时间11个月，11例存活。结论:发生在胃体上部、有褪色改变、表面有分支扩张血管的息肉应警惕胃底腺型腺癌，对于胃底腺型腺癌患者ESD可获得较好的疗效。

abstractsObjective:To investigate the clinicopathological features of gastric adenocarcinoma of fundic gland type (GA-FG).Methods:A total of 12 patients, including 7 cases treated with endoscopic submucosal dissection (ESD), were diagnosed as having GA-FG in Nanjing Drum Tower Hospital from January 2018 to August 2019. Morphological changes were analyzed by reviewing endoscopic and pathological results. Patients were followed up after definitive diagnosis.Results:The clinical symptoms of patients with GA-FG were nonspecific. No Helicobacter pylori infection was identified. The lesions were found in the non-atrophic gastric mucosa of the upper 1/3 portion in 10 cases and middle 1/3 portion in 2 cases. Endoscopically, the most common features were whitish color (9 cases), and all lesions diameter≤1 cm. Their macroscopic types were classified as 0-Ⅰ (2 cases), 0-Ⅱa (9 cases) and 0-Ⅱc (1 case) respectively. All lesions had sharp boundary, with branching dilated blood vessels on the surface. Five in 7 cases who were treated with ESD showed submucosal invasion. Immunohistochemically, 9 cases were classified as the chief cell type , 3 as the mixed type, 11 MUC6 positive, 4 MUC5AC positive, 2 MUC2 positive, and 3 CD10 positive. P53 was detected in all 12 cases, and 9 cases had low Ki-67 staining index (<10%). The mean time of follow-up was 11 months, and 11 patients survived. Conclusion:GA-FG should be taken into consideration when the polyps are found in the upper part of the stomach, with whitish color, and branch dilated blood vessels on the surface. Excellent clinical outcomes can be achieved for GA-FG patients with ESD.