伴有肠母细胞分化的胃腺癌的临床病理观察  

Clinicopathological features of gastric adenocarcinoma with enteroblastic differentiation

作　　者：赵苏苏 余泽前[2] 王剑蓉 高丽丽 刘春样 韩梅 李惠 章宜芬 ZHAO Su-su;YU Ze-qian;WANG Jian-rong;GAO Li-li;LIU Chun-yang;HAN Mei;LI Hui;ZHANG Yi-fen(Department of Pathology,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China;Department of Hepatic-Biliary-Pancreatic Center,Zhongda Hospital,Southeast University,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院,江苏省中医院病理科,南京210029 [2]东南大学附属中大医院肝胆胰中心,南京210009

出　　处：《诊断病理学杂志》2019年第12期817-821,共5页Chinese Journal of Diagnostic Pathology

基　　金：国家自然科学基金(青年基金)(项目批准号:81502505)

摘　　要：目的 研究具有肠母细胞分化的胃腺癌(GAED)的临床、病理学特点及诊断方法。方法 回顾性分析8例GAED的临床特点、形态学表现及免疫表型,并复习相关文献。结果 8例患者,男性6例、女性2例;年龄61~81岁;1例无明显症状,7例表现为消化道症状或贫血症状;肿瘤最大径为1. 2~7. 5 cm,大体以溃疡型为主,多位于胃的中下段;进展期胃癌者7例,早期胃癌者1例;伴淋巴结转移者6例;伴脉管癌栓者7例;伴神经侵犯者3例;伴肝转移者3例。镜下形态表现为具有显著透明胞质的胚胎性肠上皮分化特点。免疫组化:肿瘤细胞既不同程度表达肠型分化标记物CDX2和Mucin 2,又表达某些胚胎性分化标记物SALL4、AFP和Glypican 3,5例CCND1强阳性表达,6例TP53呈突变型表达。患者均行部分胃切除术,术后随访5~29个月,1例失访,2例死亡,5例疾病无进展生存。结论 GAED和普通型胃腺癌不同,是一种具有高度侵袭性的肿瘤,并表达肠型分化和胚胎型分化的分子标记物,其诊断和鉴别诊断应结合其特殊的形态学和免疫表型。Purpose To study the clinical and pathological features and diagnostic methods of gastric adenocarcinoma with enteroblastic differentiation(GAED).Methods The clinical features,morphological features and immunophenotype of 8 cases with GAED were retrospectively analyzed and related literatures were reviewed.Results Eight cases were 6 males and 2 females;The age ranged from 61 to 81 years old;1 case had no obvious symptoms,7 cases showed gastrointestinal symptoms or anemia symptoms;tumor maximum diameter was 1.2 cm^7.5 cm,mostly located in the middle and lower regiont of the stomach;7 cases were in advanced stage and 1 cases was in early stage;6 cases had lymph node metastasis;7 cases had vascular invasion;3 cases had neurological invasion,3 cases had liver metastases.Microscopic morphology was characterized by embryonic intestinal epithelial differentiation with significant clear cytoplasm.Immunohistochemically,tumor cells expressed different markers of intestinal differentiation(CDX2 and Mucin 2)and some embryonic differentiation markers(SALL4,AFP and Glypican 3),5 cases showed positive expression of CCND1,and 6 cases presented mutant expression of TP53.All patients underwent partial gastrectomy and were followed up for 5 to 29 months.One patient lost contact,two died,and five patients had no progression.Conclusion Compared with common gastric adenocarcinoma,GAED is a highly invasive tumor and expresses molecular markers of intestinal differentiation and embryonic differentiation.The diagnosis and differential diagnosis should be combined with the special morphology and immunophenotype.

关 键 词：肠母细胞分化 胃腺癌 产生AFP的胃癌 

分 类 号：R735.2[医药卫生—肿瘤]