伴肠母细胞分化的胃腺癌临床病理学及分子特征及c-myc在其表达的意义  

Clinicopathological and molecular characteristics and the significance of c-myc expression in gastric adenocarcinoma with enteroblastic differentiation

作　　者：赵宏颖[1] 石中月 谷雨妹 齐曼[1] 金木兰[1] 路军[1] ZHAO Hong-ying;SHI Zhong-yue;GU Yu-mei;QI Man;JIN Mu-lan;LU Jun(Department of Patholoty,Beijing Chaoyang Hospital,Capital Medical University,Beijing100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院病理科,北京100020

出　　处：《诊断病理学杂志》2021年第7期518-522,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的分析胃癌伴肠母细胞分化(GAED)的临床病理学及分子特征及C-MYC在GAED中的表达意义。方法免疫组化方法检测42例GAED中SALL4、Glypican-3、AFP、CD10,CDX2、MUC-2和c-myc表达,分析其临床病理学特征。下一代测序方法检测34例GAED的分子特征。结果 GAED与同期普通型胃癌相比具有更高的淋巴管血管侵犯和转移率,GAED具有多种组织学形态,组织学生长方式与生存无相关性。胚胎蛋白SALL4、Glypican-3和AFP表达与肿瘤大小、T分期及血管、淋巴管侵犯具有相关性。GAED高表达肠分化标志物,C-MYC在癌组织中表达升高。GAED中TP53是突变发生频率最高的基因,其次依次是MCL1、CCNE1、MYC等,与普通型胃癌突变基因存在差异。MYC基因在GAED中表现为基因扩增。结论与普通型胃腺癌相比,GAED是一类侵袭性高、预后差的肿瘤。SALL4和Glypican-3联合可以提高本肿瘤诊断率。TP53高突变是GAED的一个分子特点。MYC基因在GAED中表现为基因扩增,在癌组织中表达增强。Objective To analyze the clinicopathological and molecular features of gastric adenocarcinoma with enteroblastic differentiation(GAED)and the expression of c-myc in GAED.Methods Immunohistochemistry was used to detect the expression of SALL4,Glypican-3,AFP,CD10,CDX2,MUC-2 and c-myc in 42 cases of GAED,and the clinicopathological characteristics were analyzed.Next generation sequencing was used to detect the molecular characteristics of 34 cases of GAED.Results Compared with the common gastric cancer of the same period,GAED had higher rates of lymphatic vessel invasion and metastasis.GAED had a variety of histological morphology,and the histological growth pattern was not correlated with survival.Embryonic SALL4,Glypican-3 and AFP expression were correlated with tumor size,T stage,and vascular and lymphatic invasion.GAED was highly expressed as a marker of intestinal differentiation,and c-myc expression was elevated in cancer tissues.TP53 was the gene with the highest mutation frequency in GAED,followed by MCL1,CCNE1,MYC,etc.,which were different from the common gastric cancer mutation genes.The MYC gene manifests as gene amplification in GAED.Conclusion Compared with common gastric adenocarcinoma,GAED is a kind of tumor with high aggressiveness and poor prognosis.The combination of SALL4 and Glypican-3 can improve the diagnostic rate of this tumor.Hypermutation of TP53 is a molecular feature of GAED.The expression of MYC gene is amplified in GAED and enhanced in cancer tissues.

关 键 词：伴肠母细胞分化的胃腺癌 AFP阳性胃腺癌 C-MYC 临床病理特征 分子特征 

分 类 号：R735.2[医药卫生—肿瘤]