| Objective:Gastritis cystica profunda(GCP)is a rare gastric disease,which refers to a lesion in which the glands in the gastric mucosa infiltrate and grow below the mucosal muscle and expand into cysts under the action of endogenous or exogenous factors.Due to the lack of characteristic clinical symptoms,it is difficult to make differential diagnosis under conventional endoscopy,and most clinicians have limited understanding of it,GCP is missed or misdiagnosed to a large extent.The purpose of this study was to analyze the clinicopathological features of GCP and to improve the understanding and clinical diagnosis and treatment of GCP.Methods:A retrospective analysis was performed on 60 patients diagnosed with deep cystic gastritis after endoscopic or surgical treatment in The Affiliated Hospital of Qingdao University from April 2014 to October 2021.General information(chief complaint,age,gender),pathological information(lesion size,lesion site,accompanying lesion,HP infection,Ki-67 index),endoscopic data(site,size,morphology,surface structure),endoscopic ultrasound data(lesion origin,internal echo),CT signs and other clinical data were collected.The clinical data,endoscopic manifestations and pathological results of the patients were analyzed.The measurement data were presented in the form of (?)±S.Logistic regression was used to analyze the risk factors affecting GCP with neoplastic lesions,and the OR value(ratio)and its 95% confidence interval were calculated.P ≤0.05 was considered statistically significant.Results:The 60 patients included 46 males(76.7%)and 14 females(23.3%),with an average age of(58.28±11.2)years.Most of the clinical symptoms were atypical,including abdominal pain in 25 cases,abdominal discomfort in 12 cases,abdominal distension in 10 cases,melena in 1 case and asymptomatic in 12 cases.22 patients had elevated CEA.The incidence sites were gastric body 27 cases(45%),gastric antrum 15 cases(25%),cardia 7 cases(11.7%),fundus 5 cases(8.3%),stoma of residual stomach 4 cases(6.7%),gastric horn and duodenum 1 case(1.7%)respectively.In this study,52 CT examinations were performed,and the results showed gastric wall thickening in 28 cases,low density shadow in 4 cases,high density shadow in 1 case,poor filling in 3 cases,and no obvious abnormality in 16 cases.Endoscopic ultrasonography of the 16 patients showed uniform hypoechoic submucosal eminence in 8 cases,mixed hypoechoic with cystic structure in 3 cases,anechoic in 4 cases and hyperechoic in 1 case.38 patients underwent endoscopic submucosal dissection(ESD),18 patients underwent surgical treatment,2 patients underwent endoscopic mucosal resection(EMR),and 2 patients underwent electropolypectomy.Postoperative pathology showed 38 cases(63.3%)of neoplastic lesions,including 23 cases of adenocarcinoma,6 cases of low grade intraepithelial neoplasia,2 cases of tubular adenoma,4 cases of high grade intraepithelial neoplasia,1 case of signed-ring cell carcinoma,1 case of squamous cell carcinoma and 1 case of lipoma.There were 22 cases(36.7%)of non-neoplastic lesions,including 9 cases of chronic atrophic gastritis,7 cases of chronic non-atrophic gastritis,5 cases of gastric polyp,1 case of duodenal gastric mucosa ectopic.Immunohistochemical staining with KI-67 showed that ki-67 index >5% in 49 cases(81.7%)of the 60 cases of GCP lesions,including 37 cases of neoplastic lesions and 12 cases of non-neoplastic lesions.Conclusions:(1)GCP patients are mainly male,clinical signs and endoscopic manifestations are not classic,and clinical treatment is prone to misdiagnosis or omission.(2)CT combined with endoscopic ultrasonography is helpful for the differential diagnosis of diseases,and pathological results are required for the final diagnosis.(3)Elderly GCP patients with elevated CEA should be alert to the presence of malignant tumors.(4)Cells in GCP lesions are relatively active in proliferation and have a certain potential for malignant transformation.We should be alert to whether they are accompanied by or transformed into malignant tumors. |
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