十二指肠幽门腺腺瘤10例临床病理及GNAS、KRAS分子特征分析OA

Objective To investigate the clinicopathological characteristics and molecular genetic features of duodenal pyloric gland adenoma(PGA).Methods Ten cases of duodenal PGA confirmed by endoscopic or laparo-scopic resection were collected.Immunohistochemical staining for MUC6,MUC5AC,MUC2,and Pepsinogen I was performed.Additional β-catenin and p53 staining was conducted in cases with high-grade intraepithelial neoplasia.Sanger sequencing was employed to detect GNAS and KRAS gene mutations in all 10 cases.Results The cohort in-cluded 8 males and 2 females,with a mean age of 61 years(range 30-74 years).The average maximum tumor diam-eter was 2.0 cm(range 0.6-6.0 cm).One case underwent laparoscopic resection,while 9 were treated via endo-scopic resection.Tumors were equally distributed between the duodenal bulb and non-bulbar regions(5 cases each).Pathologically,8 cases exhibited low-grade intraepithelial neoplasia(LGIN),and 2 cases showed LGIN with focal high-grade intraepithelial neoplasia(HGIN).Immunohistochemistry revealed a pure pyloric phenotype in 5 cases and a mixed phenotype in 5 cases,with no foveolar-predominant pattern observed.Aberrant p53 or β-catenin expression was absent.Molecular analysis identified no KRAS mutations in 10 cases,while 1 of 5 tested cases harbored an exon 9 GNAS mutation.Conclusion Duodenal PGA is a rare adenoma subtype with a higher malignant potential compared to other variants,necessitating accurate recognition.Endoscopic resection remains the primary treatment,though fur-ther studies are warranted to elucidate its molecular mechanisms and optimize management strategies.