具有腺和神经内分泌双向分化及伴Paget样扩散的肛门癌合并腺癌1例并文献复习  

Anal carcinoma with bidirectional differentiation of gland and neuroendocrine and Paget-like diffusion complicated with adenocarcinoma: a case report and literature review

作　　者：王立娟[1] 曾敏[1] 郭小红[2] 王成龙 邹凌凤[1] 曹晓静 孙全[2] Wang Lijuan;Zeng Min;Guo Xiaohong;Wang Chenglong;Zou Linfeng;Cao Xiaojing;Sun Quan(Department of Pathology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China;Department of Pharmacy,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China)

机构地区：[1]重庆市中医院病理科,重庆400021 [2]重庆市中医院药剂科,重庆400021

出　　处：《中国组织化学与细胞化学杂志》2021年第6期570-574,共5页Chinese Journal of Histochemistry and Cytochemistry

基　　金：国家自然科学基金青年基金项目(82104398);2019年重庆市科研机构绩效激励引导专项(cstc2019jxjl130009);。

摘　　要：目的探讨1例具有腺和神经内分泌双向分化伴Paget样扩散的肛门癌合并腺癌的临床病理特征、组织学起源、诊断及鉴别诊断。方法应用HE染色、免疫组织化学染色对重庆市中医院收集的1例肛门具有腺和神经内分泌双向分化的癌伴Paget样扩散合并腺癌进行临床病理分析,并进行相关的国内外文献复习,探讨其临床病理特征。结果手术切除标本镜下形态:第一个肿物大部分瘤细胞呈弥漫性生长,核呈圆形或卵圆形,胞浆较少,局灶细胞可见核仁,胞质较丰富,可见印戒样细胞,肛门鳞状上皮内可见腺样分化细胞,胞浆空亮,核深染,有异型性。第二个肿物瘤细胞呈腺管状结构,核有异型,可见核分裂,呈浸润性生长。免疫组织化学显示第一种肿瘤的瘤细胞弥漫阳性表达CDX-2、CK20、Syn、CgA、CD56、CK、villin,鳞状上皮内空泡细胞阳性表达Syn、CgA、CD56、CK;第二种肿瘤阳性表达CK、CK20、CDX-2、villin。结论具有腺和神经内分泌双向分化伴Paget样扩散的肛门癌合并腺癌极其少见,应充分认识其临床病理特点,避免误诊。Objective To investigate the clinicopathological features, histological origin, diagnosis, and differential diagnosis for a case of anal carcinoma with amphicrine differentiation of glandular and neuroendocrine and Paget-like diffusion complicated with adenocarcinoma. Methods A case of anal carcinoma with amphicrine differentiation of glandular and neuroendocrine with Paget-like diffusion and adenocarcinoma collected from Chongqing Traditional Chinese Medicine Hospital was analyzed with HE staining and immunohistochemical staining, and the related literatures were reviewed to explore its clinicopathological features. Results Microscopic morphology of the resected specimen: for the first tumor mass, most tumor cells showed diffused growth, with round or oval nuclei with less cytoplasm, nucleolus and abundant cytoplasm in focal cells, signet ring-like cells and glandular differentiated cells in anal squamous epithelium, the cytoplasm was empty and bright, and the nuclei were deeply stained and atypia;for the second tumor mass, the tumor cells have glandular tubular structure, the nucleus is heteromorphic, showing mitosis and infiltrating growth pattern. Immunohistochemistry detection of the sections collected from the first tumor mass identified tumor cells with positive expression of CDX-2, CK20, Syn, CgA, CD56, CK and villin, and squamous intraepithelial vacuoles with positive expression of Syn, CgA, CD56 and CK. Cells in the second tumor mass were identified with positive expression of CK, CK20, CDX-2 and villin. Conclusion Anal carcinoma with bidirectional differentiation of gland and neuroendocrine and Paget-like diffusion complicated with adenocarcinoma is extremely rare. Its clinicopathological features should be fully recognized to avoid misdiagnosis.

关 键 词：具有腺和神经内分泌双向分化的肛门癌 腺癌 临床病理特点 免疫组织化学 

分 类 号：R735.38[医药卫生—肿瘤]