胃淋巴上皮瘤样癌临床病理特征及DHX37表达情况分析  

Analysis of clinical and pathological characteristics and DHX37 expression in lymphoepithelioma-like gastric carcinoma

作　　者：郭小冬 王环环 姬菩忠 马迎春[1] 马建武 杨艳丽[1,2] GUO Xiao-dong;WANG Huan-huan;JI Pu-zhong;MA Ying-chun;MA Jian-wu;YANG Yan-li(Department of Pathology,the 940 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army;Gansu University of Chinese Medicine,Lanzhou 730000,Gansu,China)

机构地区：[1]中国人民解放军联勤保障部队第940医院病理科 [2]甘肃中医药大学,甘肃兰州730000

出　　处：《川北医学院学报》2025年第2期137-141,共5页Journal of North Sichuan Medical College

基　　金：甘肃省科技计划资助项目(省青年科技基金,22JR5RA022);中国人民解放军联勤保障部队第940医院项目(2021yxky049)。

摘　　要：目的:探讨胃淋巴上皮瘤样癌(LELGC)临床病理特征及DHX37、PD-L1、CD4^(+)和CD8^(+)的表达情况。方法:收集10例LELGC,采用免疫组织化学标记DHX37、PD-L1、CD4^(+)、CD8^(+)及错配修复基因蛋白(MLH1,MSH2,MSH6和PMS2),采用原位杂交检测EB病毒编码的小RNA(EBER)并探究其临床病理特征。筛选临床特征相仿的10例普通型胃腺癌作为对照。结果:10例LELGC年龄(55.00±10.19)岁;男性8例,女性2例;6例发生于胃体,2例发生于胃角,1例发生于贲门,1例发生于胃窦且为残胃癌。10例手术切除大体标本肿物类型均为溃疡型,最小径为1.7 cm,最大径为7.0 cm。10例LELGC均为错配修复蛋白功能完整(pMMR)且EBER阳性,其中CD8^(+)T细胞数均大于CD4^(+)T细胞数。PD-L1的CPS评分为(35.00±14.53)分;DHX37的平均阳性表达数为(42.26±13.11)。LELGC中DHX37在淋巴细胞表达比例低于普通型胃腺癌(P<0.05),且该病PD-L1表达水平较高(P<0.05)。结论:LELGC的诊断及预后判断依赖于特征性病理形态和分子检测。细胞间质中主要以CD8^(+)T细胞为主;LELGC较普通型胃腺癌表达更高的PD-L1和更低的DHX37,可能与此类患者良好的预后及免疫治疗效果的敏感性高有一定联系,提示了DHX37、CD4^(+)、CD8^(+)和PD-L1不同表达情况可能对于影响LELGC或普通型胃腺癌预后具有重要价值。Objective:To investigate the expression of DHX37,PD-L1,CD4^(+) and CD8^(+) and the clinicopathological features in lymphoepithelioma-like gastric carcinoma(LELGC).Methods:10 cases of LELGC were collected and immunohistochemistry were used to analyze DHX37,PD-L1,CD4^(+),CD8^(+),and mismatch repair gene proteins(MLH1,MSH2,MSH6 and PMS2),in situ hybridization was performed to detect Epstein-Barr virus-encoded RNA(EBER) and investigate their clinicopathological characteristics.Selected 10 cases of conventional gastric adenocarcinoma with similar clinical features for comparison.Results:In a sample of 10 cases of LELGC,the average age was approximately(55.00±10.19) years, there were 8 male and 2 female patients.6 cases occurred in the body of the stomach, 2 in the gastric angle, 1 in the cardia, and 1 in the antrum, which was also a residual gastric cancer.All 10 surgically resected specimens presented with ulcerative lesions, with the smallest diameter measuring 1.7 cm and the largest 7.0 cm.All 10 LELGC cases showed intact mismatch repair protein function(Mismatch Repair Proficient, pMMR) and were EBER-positive, with the number of CD8^(+)-positive T cells exceeding that of CD4^(+)-positive T cells in each case.The average CPS for PD-L1 was(35.00±14.53),the average positive expression count for DHX37 was(42.26±13.11).In LELGC,the proportion of DHX37 expression in lymphocytes was lower than that in conventional gastric adenocarcinoma(P<0.05),and this condition also exhibited higher PD-L1 expression levels(P<0.05).Conclusion:The diagnosis and prognosis assessment of LELGC rely on characteristic pathological morphology and molecular testing.The stroma is predominantly infiltrated by CD8^(+)-positive T cells.Compared to conventional gastric adenocarcinoma, LELGC exhibits higher PD-L1 and lower DHX37 expression.These features may be associated with better prognosis and higher sensitivity to immunotherapy in these patients, suggesting that different expression patterns of DHX37,CD4^(+),CD8^(+),and PD-L1 might have signi

关 键 词：胃淋巴上皮瘤样癌 EB病毒 PD-L1 DHX37 肿瘤微环境 

分 类 号：R365[医药卫生—病理学] R735.2[医药卫生—基础医学]