胃黏膜内印戒细胞癌19例病理及免疫表型分析  

Histological features and associated gene protein expression in gastric signet-ring cell carcinoma

作　　者：王仰坤[1] 高春芳[1] 闫辉[1] 印剑[1] 张现伟[1] 

机构地区：[1]解放军第150中心医院病理科,济南军区医学病理中心,河南洛阳471031

出　　处：《诊断病理学杂志》2009年第6期433-436,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨胃黏膜内印戒细胞癌的病理组织学特点及免疫表型的临床意义。方法先对胃镜活检标本进行组织学观察,再经手术切除证实为胃黏膜内印戒细胞癌共19例,全部采用免疫组化SP法检测HER-2、p53、PTEN、CD44、E-cadherin等27种相关基因蛋白。结果黏膜内印戒细胞癌以浅表溃疡型最常见,其次为平坦、轻度凹陷和轻度隆起型。细胞学有6种形态:①核偏位,形成经典的印戒细胞形态,细胞质因扩张而呈球形。以细胞质内有/无黏液又分2型。②细胞核位于细胞中央,类似于组织细胞,少量/无核分裂象。③胞质强嗜酸性,且胞质内含微小黏液颗粒。④细胞体积小,核偏位或中位,有少量/无黏液。⑤无细胞核仅有含黏液的胞质轮廓。⑥退形性变的细胞,胞核多偏位且深染,胞质无/有黏液。组织学表现为腺体、腺腔结构的空泡样细胞巢,或花边状、纤细的梁状结构,或单个印戒样癌细胞散在分布。间质有较少的胶原纤维,可伴有细胞外黏液分泌。免疫表型:不同分子质量角蛋白、肿瘤相关的糖类抗原和核黏蛋白Muc-1(),而与核黏蛋白Muc-2、Muc-5AC的阳性表达呈负相关。抑癌基因p53蛋白、转移促进基因CD44蛋白、转移抑制基因nm23蛋白均有较高表达。结论胃黏膜内印戒细胞癌发病年龄轻、侵袭性强、淋巴结早期转移率高;组织病理学诊断要结合免疫表型分析,以提高早期诊断率,同时亦是评价预后的重要参考指标。Objective To investigate the histological features and associated gene protein expression of gastric signet-ring cell carcinoma. Methods Gastroscopie biopsy specimens were used to analyse the histological changes, and the diagnosis was then confirmed by pathologic examination of surgically removed tumors in 19 cases. The immunohistochemical SP method was used to detect the expression of HER-2, p53, PTEN, CD44, E-cadberin and other 27 related gene proteins. Results Intramucosal signet-ring cell carcinoma with superficial ulceration was the most common type, followed by flat type, mild depression and mild elevated types. Cytologic characteristics showed six patterns： （1） deviation nucleus, forming the classic signet ring cell morphology and the dilated cytoplasm due to spherical expansion. There existed one of two types： mucus in the cytoplasm and non-mucinons cytoplasm, or translucent appearance; （2） centrally located nucleus, similar to histiocytes： there were a small number of or no mitotic figures; （3） strong eosinophilic cytoplasm, and cytoplasm containing tiny granular mucus; （4） small cell size with nuclear deviation or central nucleus ： there was a small amount of mucus or no mucus; （5） mucus containing no nuclei, and only the outline of the cytoplasm; （6） degenerative cells with deviated nucleus and deeply stained cytoplasm with or without mucus. Histological structures showed glandular cavity or cell nest hke vacuoles, or lacy, thin trabecular structure, or a scattered single ring-like cells. There was less interstitial collagen fibers, accompanied by extraeellular mucus secretion. Immunophenotyping demonstrated that the expression of different molecular weight keratin, tumor-associated carbohydrate antigen and nuclear mucin Muc-1, which had a negative correlation with nuclear mucin Muc-2 and Muc-SAC expression. There were over expression of tumor suppressor gene p53, metastasis-promoted gene CD44, and metastasis suppressor gene nm23. Conclusion Gastric signet-ring cell car

关 键 词：胃肿瘤 印戒细胞癌 组织形态学 免疫组化 

分 类 号：R735.2[医药卫生—肿瘤]