伴肠母细胞分化的直肠腺癌临床病理学分析  

Clinicopathological features of rectal adenocarcinoma with enteroblastic differentiation

作　　者：刘杰 刘相兰 林东亮[2] 赵涵[2] 李玉军[2] 邢晓明[2] Liu Jie;Liu Xianglan;Lin Dongliang;Zhao Han;Li Yujun;Xing Xiaoming(Department of Gastroenterology,Yantai Yeda Hospital,Shandong Province,Yantai 264006,China;Department of Pathology,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]山东省烟台业达医院消化内科,烟台264006 [2]青岛大学附属医院病理科,青岛266000

出　　处：《中华病理学杂志》2023年第8期797-801,共5页Chinese Journal of Pathology

摘　　要：目的探讨伴肠母细胞分化的直肠腺癌的临床病理学特征、免疫表型及遗传学改变。方法收集2022年1—12月青岛大学附属医院(3例)和山东省烟台业达医院(1例)诊断的4例伴肠母细胞分化的直肠腺癌病例。总结其临床特征,行HE及免疫组织化学染色,并对其进行二代测序以揭示其遗传学改变。结果4例患者均为男性,中位年龄65.5岁。临床症状表现为大便性状改变、便血及消瘦。4例病例均表现为传统型腺癌与伴肠母细胞分化腺癌相互混合。肿瘤大部分由排列成管状、筛状的腺样结构构成。1例几乎全部由乳头状结构构成。伴肠母细胞分化腺癌成分肿瘤细胞呈柱状,细胞界限相对清晰,具有特征性丰富透明的胞质,形成胎儿肠道样腺体。肿瘤细胞表达SALL4(4/4)、Glypican-3(3/4)、甲胎蛋白(1/4,局灶阳性),2例p53呈异常高表达。二代测序显示2例呈TP53基因突变,1例呈KRAS基因突变。结论伴肠母细胞分化的直肠腺癌罕见,形态学及免疫组织化学显示胚胎性分化。在临床诊断工作中,需要与普通型结直肠腺癌相区别。Objective To investigate the clinicopathological features,immunophenotype,and genetic alterations of rectal adenocarcinoma with enteroblastic differentiation.Methods Four cases of rectal adenocarcinoma with enteroblastic differentiation were collected at the Affiliated Hospital of Qingdao University,Qingdao,China(three cases)and Yantai Yeda Hospital of Shandong Province,China(one case)from January to December 2022.Their clinical features were summarized.Hematoxylin and eosin stain and immunohistochemical stain were performed,while next-generation sequencing was performed to reveal the genetic alterations of these cases.Results All four patients were male with a median age of 65.5 years.The clinical manifestations were changes of stool characteristics,bloody stools and weight loss.All cases showed mixed morphology composed of conventional adenocarcinoma and adenocarcinoma with enteroblastic differentiation.Most of the tumors consisted of glands with tubular and cribriform features.In one case,almost all tumor cells were arranged in papillary structures.The tumor cells with enteroblastic differentiation were columnar,with relatively distinct cell boundaries and characteristic abundant clear cytoplasm,forming fetal gut-like glands.Immunohistochemically,the tumor cells were positive for SALL4(4/4),Glypican-3(3/4)and AFP(1/4,focally positive),while p53 stain showed mutated type in 2 cases.The next-generation sequencing revealed that 2 cases had TP53 gene mutation and 1 case had KRAS gene mutation.Conclusions Rectal adenocarcinoma with enteroblastic differentiation is rare.It shows embryonal differentiation in morphology and immunohistochemistry,and should be distinguished from conventional colorectal adenocarcinoma.

关 键 词：结直肠肿瘤 腺癌 DNA突变分析 肠母细胞分化 

分 类 号：R735.37[医药卫生—肿瘤]