阑尾杯状细胞腺癌临床病理分析  

Clinicopathological Analysis of Goblet Cell Adenocarcinoma of the Appendix

作　　者：步晓琳[1] 李宝华[1] BU Xiaolin;LI Baohua(Xinglin Branch of Xiamen University Affiliated First HospitalPathology Department,Xiamen 361000,China)

机构地区：[1]厦门大学附属第一医院杏林分院病理科,福建厦门361000

出　　处：《中华灾害救援医学》2024年第7期772-776,共5页Chinese Journal of Disaster Medicine

摘　　要：目的分析阑尾杯状细胞腺癌临床病理特征。方法选取2020年1月至2024年3月于厦门大学附属第一医院杏林分院病理科诊治的11例阑尾杯状细胞腺癌患者作为研究对象,所有患者均接受免疫组化检查,4例行基因检测。收集病历资料,分析阑尾杯状细胞腺癌的临床病理特征。结果11例阑尾杯状细胞腺癌患者经临床检查发现,在大体外观上均呈阑尾炎样,其中1例阑尾管腔明显闭塞,1例阑尾末端明显扩张,1例阑尾浆膜面暗褐色伴穿孔且浆膜面粘连。所有研究对象有2例累及回盲部,1例同时累及结肠肠壁,3例侵犯系膜,1例累及十二指肠、结肠且伴有肝肾间隙种植转移,1例淋巴结转移,3例其他部位转移。从侵犯来说,4例侵犯至阑尾浆膜下层,3例侵犯至浆膜层,1例突破浆膜,3例其他部位转移;其中8例侵犯神经(+)。高级别10例,低级别1例。T3N0M0IIA1例,PT3N2aM1b 1例,Ⅳc期1例。免疫组化染色结果:3例CK7(+),7例CK20(+),8例CDX2(+),8例syn(+),4例CD56(+),5例CgA(+),Ki-67增值指数为20%~85%,平均38.75%。基因突变两例:一例为KRAS基因2号外显子检测到G13D突变,另一例为KRAS基因和NRAS基因3号外显子检测到Q61X突变。结论阑尾杯状细胞腺癌是一种恶性肿瘤,其在形态学及生物学行为的谱系较为宽泛,恶性程度和侵袭性较高,特别是高级别的侵袭性更高,且易伴随其他病变,临床症状缺乏特异性,临床医师及病理医师应提高对阑尾杯状细胞腺癌临床病理特征的认知,以避免漏诊和误诊的发生。Objective To analyze the clinicopathological characteristics of appendiceal goblet cell adenocarcinoma.Methods This study included 11 patients diagnosed with appendiceal goblet cell adenocarcinoma at the Department of Pathology,Xiamen University Affiliated First Hospital,Xiang'an Branch,between January 2020 and March 2024.All patients underwent immunohistochemical examination,and four cases also received genetic testing.Clinical data were collected to analyze the clinicopathological characteristics of appendiceal goblet cell adenocarcinoma.Results Clinical examination of the 11 patients revealed appendicitis-like gross appearance in all cases,While one case showed significant obstruction of the appendiceal lumen,one case had notable expansion at the appendiceal tip,and one case had dark brown serosal surface with perforation and adhesions.Among all cases,two cases involved the ileocecal region,one case involved the colonic wall,three cases invaded the mesentery,one case involved the duodenum and colon with implantation metastasis in the hepatorenal space,one case had lymph node metastasis,and three cases had metastasis to other locations.In terms of invasion,four cases invaded the subserosal layer of the appendix,three cases invaded the serosal layer,one case penetrated the serosa,and three cases had metastasis to other sites.Eight cases showed nerve invasion.There were ten high-grade cases and one low-grade case.Staging included one case of T3N0M0IIA,one case of PT3N2aM1b,and one case of stage IVc.Immunohistochemical results were CK7+in 3 cases,CK20+in 7 cases,CDX2+in 8 cases,syn+in 8 cases,CD56+in 4 cases,and CgA+in 5 cases.The Ki-67 proliferation index ranged from 20%to 85%,with an average of 38.75%.Genetic mutations were detected in two cases:one had a G13D mutation in exon 2 of the KRAS gene,and the other had a Q61X mutation in exon 3 of the KRAS and NRAS genes.Conclusion Appendiceal goblet cell adenocarcinoma is a malignant tumor with a broad spectrum of morphological and biological behaviors,exhibiting hig

关 键 词：阑尾肿瘤 腺癌 免疫 基因 病理学 临床 

分 类 号：R735[医药卫生—肿瘤]