EB病毒相关性胃癌的临床病理特征  

Clinicopathological characteristics of Epstein-Barr virus-associated gastric cancer

作　　者：梅静 刘永仙 芮军 赵明明 王珝 王耀辉 MEI Jing;LIU Yongxian;RUI Jun;ZHAO Mingming;WANG Xu;WANG Yaohui(Department of Pathology,People’s Hospital of Dangtu County,Ma’anshan 243100;Department of Medical Oncology,Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029;Department of Pathology,Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029;Department of Thoracic Surgery,People’s Hospital of Dangtu County,Ma’anshan 243100,China)

机构地区：[1]当涂县人民医院病理科,马鞍山243100 [2]南京中医药大学附属医院/江苏省中医院肿瘤内科,南京210029 [3]南京中医药大学附属医院/江苏省中医院病理科,南京210029 [4]当涂县人民医院胸外科,马鞍山243100

出　　处：《临床与病理杂志》2025年第1期1-8,共8页Journal of Clinical and Pathological Research

基　　金：江苏省卫生健康委员会医学科研项目(H2023098)。

摘　　要：目的:胃癌具有显著的肿瘤异质性,EB病毒相关性胃癌(Epstein-Barr virus-associated gastric cancer,EBVaGC)对免疫检查点抑制剂治疗反应好,预后良好。本研究旨在探讨EBVaGC的临床病理特征,为临床上对患者进行个性化免疫治疗提供参考。方法:收集南京中医药大学附属医院/江苏省中医院和当涂县人民医院的EBVaGC患者20例,对其一般临床特征、HE染色结果、免疫组织化学染色结果及EBV编码的小RNA(Epstein-Barr virus-encoded small RNA,EBER)原位杂交结果进行回顾性分析。结果:20例EBVaGC患者均为男性,平均年龄60岁,肿瘤最大径1.0~9.5 cm,主要为溃疡型,多见于贲门和胃底/体。HE染色结果显示黏膜固有层可见少量上皮内瘤变腺体,瘤变腺体逐渐形成吻合或分支状结构,呈“花边样”图案,肿瘤细胞逐渐移行为界限不清的不规则团块状、片状、小梁或小管状结构,伴有明显的淋巴细胞浸润。肿瘤细胞呈多边形细胞,边界不清,形成合胞体结构;细胞核呈空泡状,有明显的核仁。在接受胃癌根治术的19例患者中,早期胃癌(1例T1a期患者和4例T1b期)患者均未见淋巴结转移,有9例(9/14,64.28%)进展期胃癌患者发生淋巴结转移。原位杂交结果显示18例患者EBER呈弥漫性阳性表达,2例患者管状腺癌区EBER表达阴性而实性区域EBER表达阳性。免疫组织化学染色结果显示20例患者的错配修复(mismatch repair,MMR)蛋白MLH1、PMS2、MSH2、MSH6表达均为阳性(保留表达)。无患者HER-2表达为阳性(3+)。结论:EBVaGC在胃癌中不罕见,早期淋巴结转移风险低,仔细观察组织学形态,结合免疫组织化学和EBER原位杂交标记可以准确诊断。Objective:Gastric cancer exhibits significant tumor heterogeneity.Epstein-Barr virus-associated gastric cancer(EBVaGC)responds well to immune checkpoint inhibitor therapy and is associated with favorable prognosis.This study aims to explore the clinicopathological characteristics of EBVaGC to provide a reference for personalized immunotherapy in clinical practice.Methods:Twenty cases of EBVaGC were collected from the Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Chinese Medicine and the People’s Hospital of Dangtu County.A retrospective analysis was conducted on their general clinical characteristics,HE staining results,immunohistochemical staining results,and in-situ hybridization results for Epstein-Barr virus-encoded small RNA(EBER).Results:All 20 EBVaGC patients were male,with an average age of 60 years.Tumor diameters ranged from 1.0 to 9.5 cm,primarily presenting as ulcerative type,and were most commonly located in the cardia,fundus,and body of the stomach.HE staining showed a small number of intraepithelial neoplastic glands in the lamina propria,gradually forming anastomosing or branched structures in a“lace-like”pattern.Tumor cells gradually transitioned into poorly defined irregular clusters,sheets,trabeculae,or tubular structures,accompanied by prominent lymphocyte infiltration.Tumor cells were polygonal with indistinct borders,forming syncytial structures;nuclei were vacuolated with prominent nucleoli.Among 19 patients who underwent radical gastrectomy,none of the early-stage cases(1 patient at T1a and 4 patients at T1b)had lymph node metastasis,while 9 out of 14(64.28%)patients with advanced gastric cancer showed lymph node metastasis.In-situ hybridization showed diffuse EBER positivity in 18 patients,and in 2 patients,EBER was negative in tubular adenocarcinoma areas but positive in solid areas.Immunohistochemical staining showed all 20 patients retained positive expression of mismatch repair(MMR)proteins MLH1,PMS2,MSH2,and MSH6.None of the patients

关 键 词：EB病毒相关性胃癌 临床病理特征 淋巴结转移 EBV编码的小RNA 免疫治疗 

分 类 号：R735.2[医药卫生—肿瘤]