胃具有腺和神经内分泌双向分化的癌12例临床病理学观察  

Gastric cancer featuring bidirectional differentiation into glandular and neuroendocrine tissues:a clinicopathological analysis of 12 cases

作　　者：马怡晖[1] 李佳静 秦慧[1] 王丰[1] 王英姿[1] 庞霞[1] 李晨飞[1] 李珊珊[1] Ma Yihui;Li Jiajing;Qin Hui;Wang Feng;Wang Yingzi;Pang Xia;Li Chenfei;Li Shanshan(Department of Pathology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院病理科,郑州450052

出　　处：《临床与实验病理学杂志》2025年第3期311-316,共6页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨胃具有腺和神经内分泌双向分化的癌(amphicrine carcinoma,AC)临床病理学特征。方法收集12例胃AC患者的临床资料,观察其临床病理特征和组织学特征,采用免疫组化、特殊染色和电镜技术分析其免疫表型、超微结构,应用分子病理检测微卫星状态,并复习相关文献。结果10例胃AC位于食管胃结合部/贲门,1例位于胃角,1例位于胃窦;肿块最大径平均4.25 cm。4例标本同时存在神经内分泌癌成分,另有4例同时存在腺癌成分。11例有神经侵犯和脉管癌栓;11例侵及浆膜层/浆膜下层,1例侵及黏膜下层;10例有淋巴结转移癌。12例均弥漫表达CKpan和Syn,3例弥漫表达CgA,7例弥漫表达CD56;Ki67增殖指数平均78.9%。特殊染色示肿瘤细胞内有明确黏液;电镜检查发现癌细胞内有电子致密颗粒和黏液颗粒。随访10例患者有7例存活,另3例于术后0、24、30个月因全身多处转移死亡。结论胃AC多见于食管胃结合部/贲门,组织学有较高的侵袭性,其明确诊断依赖于组织学特征、免疫表型和特殊染色。Purpose To explore the clinical and pathological characteristics of gastric amphicrine carcinoma(AC).Methods Clinical data of 12 patients with gastric AC were collected,and their clinical pathological characteristics and histological morphology were observed.Immunohistochemical staining,special staining,and electron microscopy techniques were used to analyze their immune phenotype and ultrastructure.Molecular pathology was used to detect microsatellite status.Relevant literature was reviewed.Results Ten cases of gastric AC were located at the junction of the esophagus and stomach/cardia,1 case at the gastric angle,and 1 case in the gastric antrum.The average maximum diameter of tumors was 4.25 cm.There were different proportions of tumor cells with signet-ring like characteristics in all cases.Four cases had neuroendocrine carcinoma components,and another 4 had adenocarcinoma.Eleven cases had nerve invasion and vascular cancer thrombus.Eleven cases invaded the serosal layer/submucosal layer,and 1 case invaded the submucosal layer.Ten cases had lymph node metastasis.All 12 cases showed diffuse expression of CKpan and Syn,with 3 cases showed diffuse expression of CgA and 7 cases showed diffuse expression of CD56.The average proliferation index of Ki67 was 78.9%.Special staining showed clear intracellular mucus.Electron microscopy examination revealed electron dense particles and mucus particles within the tumor cells.A total of 10 patients were followed up,of which 7 survived,and 3 patients died from multiple systemic metastases at 0,24,and 30 months postoperatively.Conclusion Gastric AC was more common in the junction of the esophagus and stomach/cardia,and histology shows a higher invasiveness.Their clear diagnosis depends on histological morphology,immunohistochemistry,and special staining.

关 键 词：胃肿瘤 腺癌 神经内分泌癌 双向分化 

分 类 号：R737.9[医药卫生—肿瘤]