伴肠母细胞分化的胃腺癌临床病理特征分析  

Analysis of the clinicopathological characteristics of gastric adenocarcinoma with enteroblastic differentiation

作　　者：陈青 叶涛 CHEN Qing;YE Tao(Linyi Central Hospital,Linyi 276400,China)

机构地区：[1]山东省临沂市中心医院,276400

出　　处：《中国实用医药》2025年第3期70-72,共3页China Practical Medicine

摘　　要：目的探讨伴肠母细胞分化的胃腺癌的临床病理学特征及免疫组化表型。方法收集15例伴肠母细胞分化的胃腺癌患者,行HE及免疫组化染色,分析其临床病特征及理特征。结果15例患者中,14例为男性,1例为女性,平均年龄68岁。临床症状多表现为腹痛、腹胀、消瘦乏力等胃癌的临床表现特征。7例为活检标本并影像学诊断远处转移,其中4例发生肝转移,并进行了肝脏穿刺。8例为根治手术切除,术后均辅助化学治疗。大体观察中,8例根治标本均为溃疡型肿块,其中7例浸润胃壁全层并侵及浆膜,其中1例发生穿孔,1例浸透浆膜并累及部分肝组织;仅1例侵及黏膜下层。15例镜下表现均为传统的腺癌与伴肠母细胞分化的胃腺癌相混合,伴肠母细胞分化的胃腺癌占比不等,约10%~80%。伴肠母细胞分化的胃腺癌肿瘤细胞呈柱状,细胞界限清楚,细胞质丰富透明具有特征性,透明的胞质可以形成核上或者核下的空泡,类似分泌期的子宫内膜。伴肠母细胞分化的区域均有弱或强,强度不等的锌指纹结构转录因子(SALL4)(13/15)、磷脂酰肌醇蛋白聚糖-3(Glypican-3)(11/15)、甲胎蛋白(AFP)(7/15),其中AFP表达多为局灶性弱阳性,P53错义突变者8例。结论伴肠母细胞分化的胃腺癌少见,容易发生于老年男性中,形态学及免疫组化提示胚胎性分化,发现时容易处于晚期,预后较差,临床诊断工作中,需与普通型胃腺癌区分开。Objective To explore the clinicopathological characteristics and immunohistochemical phenotype of gastric adenocarcinoma with enteroblastic differentiation.Methods 15 cases of gastric adenocarcinoma with enteroblastic differentiation were collected and stained with HE and immunohistochemistry to analyze their clinical and pathological features.Results Among the 15 patients,14 cases were male and 1 case was female,with an average age of 68 years.The clinical symptoms were mostly characterized by abdominal pain,abdominal distension,emaciation and fatigue and other clinical manifestations of gastric cancer.Biopsy specimens from 7 patients were diagnosed as distant metastases by imaging,of which liver metastases occurred in 4 cases and liver puncture was performed.8 patients were treated with radical surgical resection and adjuvant chemotherapy after operation.In the gross observation,all the specimens of 8 patients with radical treatment were ulcerative masses,7 of which infiltrated the entire gastric wall and invaded the serous membrane,with 1 case of perforation and 1 case infiltrated the serous membrane and involved part of the hepatic tissue;only 1 case invaded the submucosa.Microscopically,all 15 cases showed traditional adenocarcinoma mixed with gastric adenocarcinoma with enteroblastic differentiation,and the percentage of gastric adenocarcinoma with enteroblastic differentiation varied from about 10%-80%.Gastric adenocarcinoma tumor cells with enteroblastic differentiation were columnar,with clear cell boundaries and characteristic abundant transparent cytoplasm,and the transparent cytoplasm could form supranuclear or subnuclear vacuoles,similar to endometrium in secretory phase.The regions with enteroblastic differentiation all had weak or strong,varying intensity of spalt-like transcription factor 4(SALL4)(13/15),Glypican-3(11/15),alpha-fetoprotein(AFP)(7/15),of which AFP expression was mostly focal and weakly positive,and there were 8 cases of P53 missense mutation.Conclusion Gastric adenocarcinoma with e

关 键 词：胃腺癌 伴肠母细胞分化 病理诊断 免疫组化特征 

分 类 号：R735.2[医药卫生—肿瘤]