EBV相关性伴淋巴样间质胃癌4例临床病理分析  

Clinicopathologic analysis of 4 cases of Epstein-Barr virus-associated gastric carcinoma with lymphoid stroma

作　　者：林泽泱 廖洪锋[1] 郭舒静 庄国洪[2] 叶宇涵 白婷婷 刘争进[1] 殷平[1] LIN Ze-yang;LIAO Hong-feng;GUO Shu-jing;ZHUANG Guo-hong;YE Yu-han;Bai Ting-ting;LIU Zheng-jin;YIN Ping(Department of Pathology,Zhongshan Hospital of Xiamen University,Xiamen 361004,China;Organ Transplantation Institute,School of Medicine,Xiamen University,Xiamen 361004,China)

机构地区：[1]厦门大学附属中山医院病理科,厦门361004 [2]厦门大学医学院器官移植研究所,厦门361004

出　　处：《临床与实验病理学杂志》2021年第12期1431-1435,共5页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨EBV相关性伴淋巴样间质胃癌(Epstein-Barr virus-associated gastric carcinoma with lymphoid stroma,EBVaGCLS)的临床病理学特征、免疫表型、分子遗传学特征及预后。方法收集4例EBVaGCLS的临床病理学资料,采用免疫组化EnVision两步法及原位杂交法标记肿瘤细胞,分析其临床、病理形态学特征,及与预后的关系,并复习相关文献。结果4例均为男性,年龄60~66岁,平均62岁。肿瘤位于近端胃,最大径4.2~8.7 cm,平均6.8 cm。癌组织浸润性生长,一般呈梁状、条索状、片状或不规则腺管状。肿瘤细胞较大,合体样多角形。间质伴大量成熟淋巴细胞浸润,可形成淋巴滤泡。免疫表型:肿瘤细胞CKpan、CK-L、CK7、错配修复蛋白(MLH1、PMS2、MSH2、MSH6)均阳性,间质淋巴细胞CD3、CD20均阳性,AFP、Heppar-1均阴性,Ki-67增殖指数为20%~80%。4例EBER原位杂交均呈阳性。4例患者平均随访9个月,其中1例死亡。结论EBVaGCLS多发生于中老年人,临床症状相较于分化型胃癌无特殊,诊断和鉴别诊断依赖于其特征性形态学表现并辅以免疫组化、原位杂交检测。EBVaGCLS预后好于EBV阴性胃癌,治疗以手术完整切除为主。Purpose To investigate the clinicopathological features,immunophenotype,molecular characteristics and prognosis of EBV associated gastric carcinoma with lymphoid stroma(EBVaGCLS).Methods The clinicopathological and follow-up data of four cases were collected.Immunohistochemical staining and EBER in situ hybridization were performed,and the relevant literatures was reviewed.Results All 4 cases were male,aged 60-66 years with mean age of 62 years.EBVaGCLS occurred in the proximal stomach,with a mean diameter of 6.8(4.2-8.7)cm.Histologically,EBVaGCLS was characterized by irregular sheets,trabeculae,ill-defined tubules,or syncytia of polygonal cells which embedded with extensive lymphocytic infiltrations in the stroma.The lymphoid stroma evenly formed lymphoid follicles.Immunohistochemistry,tumor cells were positive for CKpan,CK-L,CK-7,MMR(MLH1,PMS2,MSH2,MSH6),but negative for AFP or Heppar-1.The lymphocytes within the stroma were positive for CD3,CD20.The Ki-67 labelling index was usually 20%-80%.EBER was positive in all cases by in situ hybridization.Four patients were followed up for a mean of 9 months,one case died.Conclusion EBVaGCLS occurs mostly in middle-aged and elderly people.There are no special clinical symptoms compared with EBV-negative gastric carcinoma(EBVnGC).Its diagnosis and differential diagnosis depend on the morphological characteristics,immunohistochemical staining and EBER detection.The prognosis of EBVaGCLS is better than that of EBV-negative gastric cancer.The primary treatment option is surgical resection.

关 键 词：胃肿瘤 EBV相关性伴淋巴样间质胃癌 免疫组织化学 诊断 鉴别 预后 

分 类 号：R735.2[医药卫生—肿瘤]