食管基底细胞样鳞癌合并胃腺癌的多原发癌  

Multiple primary carcinomas including esophageal basaloid squamous cell carcinoma and gastric adenocarcinoma

作　　者：王红霞[1] 陈昊[1] 刘雨成[2] 白玲[1] 杨聪颖[1] 闫蓉[1] 江亚军[3] 

机构地区：[1]连云港市第一人民医院病理科,222002 [2]连云港市第一人民医院丢学影像科,222002 [3]连云港市第二人民医院血液肿瘤科,222002

出　　处：《中华消化外科杂志》2013年第10期746-749,共4页Chinese Journal of Digestive Surgery

摘　　要：同时或者在6个月内发生的2种或2种以上原发性恶性肿瘤称为同时性多原发癌，发病率较低。2011年10月连云港市第一人民医院收治了1例食管基底细胞样鳞癌同时合并胃腺癌患者。该例患者以吞咽困难为主要症状，胃镜检查示食管、贲门至胃底多发包块，CT检查示食管中段隆起性包块，食管贲门至胃底管壁增厚，增强扫描见病灶轻度强化。左胸径路食管贲门癌切除术后病理检查示食管基底细胞样鳞癌，贲门中分化腺癌。食管基底细胞样鳞癌光镜下见粉刺样坏死和红染的基底膜样物，免疫组织化学检查示细胞角蛋白5／6、P63阳性，细胞角蛋白弱阳性，突触素、嗜铬颗粒素A和CD117均为阴性。随访4个月，患者出现胸腔积液和多发肝转移，于2012年5月死于肝转移。食管基底细胞样鳞癌合并胃腺癌的多原发癌临床上较为罕见，诊断和鉴别诊断主要依靠组织学形态和免疫组织化学检查，治疗可选择手术切除联合术后放、化疗，但预后较差。Synchronous multiple primary carcinomas refers to 2 or more than 2 kinds of different primary malignant tumors develop synchronously or in 6 months. The incidence of synchronous multiple primary carcinoma is low. A patient with esophageal basaloid squamous cell carcinoma （BSCC） and gas tric adenocarcinoma was admitted to the First People＇s Hospital of Lianyungang in October 2011. The main symptom of this patient was dysphagia, and multiple lesions were found in esoph agus, cardia and stomach fundus by gastroseopy respectively. On computed tomography image, eminence lesion in esophageal nfidpiece and wall thickening from esophagus-eardia to stomach fundus were displayed and were both enhanced slightly by enhancement scanning. The esophageal and cardia tumors wereresected via left thoracic approach, and postoperative pathological examination revealed esophageal BSCC and moderately differ entiated adenocarcinoma of cardia respectively. Comedo necrosis and red basal membrane material were seen under light micro scope. The expressions of cytokeratin 5/6 and P63 were posi tive, the expression of cytokeratin L was weak positive and the expressions of synaptophysin, chromogranin A and CD117 were negative. The patient suffered from pleural effusion and multiple liver metastases after 4 months follow-up and died of liver metastases in May 2012. Multiple primary carcinomas including esophageal BSCC and gastric adenocarcinoma are rarely seen in clinical practice. Their diagnosis and differential diagnosis mainly depend on histological morphology and immunohistochemical method. Surgical resection combined with postoperative radiotherapy and chemotherapy is selectable, but the prognosis is poor.

关 键 词：食管肿瘤 胃肿瘤 多原发肿瘤 

分 类 号：R735.1[医药卫生—肿瘤] R735.2[医药卫生—临床医学]