新辅助化疗后食管癌病理形态学改变  

Morphologic changes of esophageal carcinoma after neoadjuvant therapy

作　　者：李军扩[1] 朱青山[2] 纪媛媛[3] 周福有[4] 郭梅[1] 杨海军[1] 

机构地区：[1]安阳市肿瘤医院病理科,河南安阳455000 [2]安阳市肿瘤医院放疗科,河南安阳455000 [3]安阳市肿瘤医院肿瘤内科,河南安阳455000 [4]安阳市肿瘤医院胸外科,河南安阳455000

出　　处：《诊断病理学杂志》2017年第9期680-683,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的总结新辅助化疗后食管癌组织、癌旁食管组织及周围淋巴结的形态学改变,并提出相关鉴别诊断要点。方法收集新辅助化疗病例85例,治疗前均行胃镜活检,病理诊断明确。回顾分析新辅助化疗后切除标本的组织形态,观察癌组织、癌旁食管组织及周围淋巴结在治疗后的改变。结果肿瘤组织大体形态和肿瘤细胞形态发生较多改变。肿瘤组织出现不同程度的退变及间质纤维化等改变,肿瘤细胞出现分化更差的形态改变。淋巴结萎缩,转移灶可发生与原发灶相似的治疗后改变。癌旁鳞状上皮组织表现为棘层肥厚、棘层松解,气球样变和角质囊肿形成。退变的肿瘤细胞、合体癌细胞等需与泡沫组织细胞、多核巨细胞等鉴别。免疫组化染色(AE1/AE3、MNF-116、CD68等)有助于诊断。结论食管癌新辅助化疗后的形态学改变会造成诊断困难,回顾治疗前胃镜病理切片、充分取材及免疫组化染色有助于诊断与疗效评价。Objective To investigate the morphologic changes of esophageal carcinoma,para-cancer and normal tissues after neoadjuvant therapy and to indicate the key points of differential diagnosis. Methods 85 cases of esophageal carcinoma after neoadjuvant therapy were analyzed. Review of biopsy pathological sections was conducted before neoadjuvant therapy. The HE-stained sections after operation were reviewed,and the changes of the cancer,para-cancer and normal tissues were collected. Results The main changes of esophageal carcinoma after neoadjuvant therapy were cellular degeneration,stromal fibrosis and others. These changes were often upgrading of the tumor to a poorly differentiated carcinoma. Lymph node was atrophy. The morphologic changes of lymph node were similar to that of the original site. The squamous epithelium of para-cancer showed acanthosis, focal acantholysis, ballooning and cystic degeneration of keratinocytes. Conclusion The morphologic changes of esophageal carcinoma after neoadjuvant therapy may be one of difficulties in diagnosis. Sufficient examination of specimen and immunohistochemistry（ AE1/AE3,MNF-116 and CD68）may help solve this problem.

关 键 词：食管癌 新辅助化疗 免疫组化 

分 类 号：R735.1[医药卫生—肿瘤]