摘要
目的探讨伴有肠母细胞分化的胃腺癌(gastric canceRwith enteroblastic differentiation,GCED)的临床病理学特征、诊断、鉴别诊断,提高病理医师对GCED的认识和诊断能力。方法应用免疫组化EnVision法检测377例胃癌中SALL4、GPC3和AFP的表达,分析GCED的临床病理学特征,比较GCED和非GCED(非伴有肠母细胞分化的胃癌)的临床病理特征间的差异。结果GCED发病率为10.8%(41/377)。41例GCED患者发病年龄39~80岁,平均64.8岁;男性33例,女性8例,男女比约4∶1;肿瘤最大直径1.5~18 cm,平均5.53 cm;早期胃癌3例,进展期胃癌38例。GCED呈管状、乳头状、筛状和实性片巢状,肿瘤细胞立方形、柱状或多角形,核圆形,胞质透亮或嗜酸。SALL4、GPC3和AFP阳性率分别为53.7%、53.7%和80.5%。与非GCED相比,GCED具有更高的脉管侵犯、淋巴结转移率和更高的病理分期(P<0.05),而发病年龄、性别、部位、浸润深度及神经侵犯等差异无显著性(P>0.05)。GCED的Lauren分型多为肠型和混合型。GCED患者血清AFP水平明显高于非GCED患者(P<0.05)。结论GCED是一种形态学少见且具有独特临床病理学特征的恶性肿瘤,与非GCED相比,其具有更强侵袭性的临床生物学行为。
Purpose To explore the clinicopathological characteristics,diagnosis and differential diagnosis of gastric adenocarcinoma with enteroblastic differentiation(GCED)and to improve the understanding and diagnostic ability of pathologists on GCED.Methods The expressions of SALL4,GPC3 and AFP in 377 gastric cancers were detected by EnVision stain.The clinicopathological morphology of 377 cases of gastric canceRfrom were analyzed retrospectively and the differences of clinicopathological features between GCED and non-GCED were compared.Results The morbidity of GCED was 10.8%(41/377).Among the 41 cases of GCED,the age of onset was 39 to 80 years old(mean 64.8 years),33 cases were males and 8 cases were females,the ratio of male to female was about 4 to 1,the maximum diameteRof tumoRwas 1.5 cm to 18 cm with the average of 5.53 cm,3 cases were early gastric canceRand 38 cases were advanced gastric cancer.Histologically,GCED was predominantly arranged in tubular,papillary,cribriform,solid sheet and nest and tumoRcells were cuboidal,columnaRoRpolyhedral with round nucleus,cleaRoReosinophilic cytoplasm.By immunohistochemical,the positive rates of SALL4,GPC3 and AFP were 53.7%,53.7%and 80.5%.Compared with non-GCED,GCED had higheRvasculaRinvasion and lymph node metastasis probability and higheRpathological stage(P<0.05).But there was no significant difference in age,sex,location,depth of invasion and nerve invasion(P>0.05).In Lauren classification,GCED was mostly intestinal type and mixed type.The serum AFP level in GCED patients was significantly higheRthan that in non-GCED patients(P<0.05).Conclusion Gastric adenocarcinoma with enteroblastic differentiation is a rare malignant tumoRwith unique clinicopathological features and it has more aggressive clinical and biological behaviors compared with non-GCED.
作者
苟思琪
张前
方媛
杨路路
王劲松
齐琼
彭雅琴
黄文斌
GOU Si-qi;ZHANG Qian;FANG Yuan;YANG Lu-lu;WANG Jin-song;QI Qiong;PENG Ya-qin;HUANG Wen-bin(Department of Pathology,Nanjing Medical University,Nanjing 210006,China;Department of ComputeRScience and Engineering,Sanjiang University,Nanjing 210012,China)
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2020年第1期6-10,共5页
Chinese Journal of Clinical and Experimental Pathology
基金
南京市医学科技发展项目(YKK17120)
南京市卫生青年人才基金(QRX17154)
江苏省高校自然科学基金(17KJB520032)
