腺瘤样腺癌10例临床病理学及分子学特征  

Clinicopathological and molecular pathologic features of colorectal adenoma-like adenocarcinoma

作　　者：周文斌[1] 张爱 杨路路 王劲松[1] 黄文斌[1] ZHOU Wen-bin;ZHANG Ai;YANG Lu-lu;WANG Jin-song;HUANG Wen-bin(Department of Pathology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)病理科,南京210006

出　　处：《临床与实验病理学杂志》2023年第4期410-415,共6页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨腺瘤样腺癌的临床病理学及分子学特征。方法收集10例腺瘤样腺癌和46例高分化非特殊型腺癌的手术切除标本,采用免疫组化EnVision法检测MLH1、MSH2、MSH6、PMS2蛋白表达;采用ARMS法和荧光定量PCR法检测10例腺瘤样腺癌和6例高分化非特殊型腺癌中KRAS、NRAS、PIK3CA和BRAF基因突变情况。结果腺瘤样腺癌大体类型上均为息肉型。腺瘤样腺癌与高分化非特殊型腺癌相比,在患者性别、年龄、肿瘤最大径、发生位置、T分期等指标上差异均无统计学意义(P>0.05)。7例术前行病理活检,镜下发现腺体有明显的黏液分泌旺盛现象。错配修复蛋白检测显示均为错配修复基因完整型,分子检测显示2例有KRAS基因突变。生存分析显示,所有腺瘤样腺癌患者均生存,而高分化非特殊型腺癌的总生存率为72.5%。结论腺瘤样腺癌是一种少见的结直肠腺癌类型,具有良好的生物学行为和预后,以及独特的分子特征。术前活检绒毛状腺瘤腺上皮黏液分泌亢进可能为腺瘤样腺癌的一个组织学特征。Purpose To explore the clinicopathological and molecular features of colorectal adenoma-like adenocarcinoma.Methods 10 cases of colorectal adenoma-like adenocarcinoma and 46 cases of well differentiated adenocarcinoma,of no special type(NOS)from surgically resected specimens were collected,and the expression of protein of mismatch repair gene was detected by immunohistochemistry.Meanwhile,the molecular detection of KRAS,NRAS,PIK3CA and BRAF in 10 cases of colorectal adenoma-like adenocarcinoma and 6 cases of well differentiated adenocarcinoma,NOS was examined by ARMS-PCR method.Results Grossly,colorectal adenoma-like adenocarcinoma was polypoid-type.Compared with well differentiated adenocarcinoma,NOS,adenoma-like adenocarcinoma was no significant differences in gender,age,tumor size,location and T stage(P>0.05).Analysis of pathologic section of 7 cases with preoperative biopsies showed significant mucus secretion within the glands.The detection of mismatch repair protein showed proficient MMR,the molecular detection showed there were KRAS gene mutation in 2 cases of adenoma-like adenocarcinoma.Survival analysis showed that all patients with adenoma-like adenocarcinoma survived,while the overall survival rate for well differentiated adenocarcinoma,NOS was 72.5%.Conclusion Colorectal adenoma-like adenocarcinoma is a rare subtype of colorectal adenocarcinoma with good biological behavior,better prognosis,and unique molecular characteristics.Hypersecretion of mucus from the adenomatous epithelium from preopertative biopsy may suggest a histological feature of adenoma-like adenocarcinoma.

关 键 词：结直肠肿瘤 腺瘤样腺癌 高分化非特殊型腺癌 分子特征 免疫组织化学 

分 类 号：R735.3[医药卫生—肿瘤]