原发性鼻腔低级别非肠型腺癌1例并文献复习  

Primary low-grade non-intestinal-type adenocarcinoma of the nasal cavity:A case report and literature review

作　　者：杨阳[1] 李果 吴向阳 张功学[1] YANG Yang;LI Guo;WU Xiangyang;ZHANG Gongxue(Department of Pathology,Zaoyang First People’s Hospital,Zaoyang Hubei 441299;Department of Otolaryngology,Zaoyang First People’s Hospital,Zaoyang Hubei 441299;Department of Medical Imaging,Zaoyang First People’s Hospital,Zaoyang Hubei 441299,China)

机构地区：[1]枣阳市第一人民医院病理科,湖北枣阳441299 [2]枣阳市第一人民医院耳鼻喉科,湖北枣阳441299 [3]枣阳市第一人民医院医学影像科,湖北枣阳441299

出　　处：《临床与病理杂志》2023年第10期1895-1900,共6页Journal of Clinical and Pathological Research

基　　金：枣阳市科学技术和经济信息化局卫生项目(202106)。

摘　　要：原发性鼻腔非肠型腺癌(non-intestinal-type adenocarcinoma,non-ITACs)是一种罕见病,缺乏特异的临床表现,术前诊断较困难。2022年1月5日枣阳市第一人民医院收治1例non-ITACs女性患者,75岁,因左侧鼻塞1年余,加重1个月余入院。鼻窦冠状位CT示左侧上颌窦壁骨质破坏,左侧上颌窦肿瘤性病变可能,不排除炎性病变。镜下肿瘤呈腺样增生,以背靠背或相互衔接的方式排列,局部呈乳头状结构,膨胀性浸润性生长。局部细胞呈高柱状,伴有明显的细胞内黏液,细胞核轻-中度异型,核分裂象可见。免疫组织化学染色示肿瘤细胞细胞角蛋白7(cytokeratin 7,CK7)(+),CK20、Villin、尾型同源盒转录因子2(caudal-related homeobox transcription factor,CDX2)、特异AT序列结合蛋白2(specific AT sequence binding protein 2,SATB-2)、癌胚抗原(carcinoembryonic antigen,CEA)、甲状腺转录因子(thyriod transcription factor-1,TTF-1)、P40、S-100、SOX10、配对盒基因8蛋白(paired box protein 8,PAX-8)均(-),Ki-67(增殖指数为10%)。non-ITACs可以依据临床及病理组织学特征,并结合免疫组织化学染色明确诊断,分子诊断结果可以为该肿瘤的治疗提供有力帮助。Primary nasal non-intestinal-type adenocarcinoma(non-ITACs)of the nasal cavity is a rare disease with a lack of specific clinical manifestations,posing challenges for preoperative diagnosis.On January 5,2022,a 75-year-old female patient with non-ITACs was admitted to the First People’s Hospital of Zaoyang City due to more than a year of left nasal congestion,worsening over the past month.Coronal CT of the nasal sinuses showed bone destruction of the left maxillary sinus wall,suggesting a tumor-like lesion in the left maxillary sinus,with the possibility of inflammatory changes not ruled out.Under the microscope,the tumor presented adenoid hyperplasia arranged in a distinctive back-to-back or interconnected manner,with local papillary structures and expansile infiltrative growth.The local cells were highly columnar,showing significant intracellular mucin,mild to moderate nuclear atypia,and visible mitotic figures.Immunohistochemistry staining showed positive expression for cytokeratin 7(CK 7),while CK 20,Villin,caudal-related homeobox transcription factor(CDX 2),specific AT sequence binding protein 2(SATB-2),carcinoembryonic antigen(CEA),thyroid transcription factor-1(TTF-1),P 40,S-100,SOX 10,and paired box protein 8(PAX-8)were negative.Ki-67 proliferation index was 10%.Non-ITACs can be diagnosed based on clinical and histopathological features,combined with immunohistochemistry staining.Molecular diagnostic results can provide valuable assistance in the treatment of this tumor.

关 键 词：鼻腔 非肠型腺癌 免疫组织化学 鉴别诊断 

分 类 号：R739.62[医药卫生—肿瘤]