伴有肠母细胞分化胃腺癌临床病理分析

目的探讨伴有肠母细胞分化的胃腺癌(gastric cancer with enteroblastic differentiation, GCED)的临床病理学特征、诊断、鉴别诊断,提高病理医师对GCED的认识和诊断能力。方法应用免疫组化EnVision法检测377例胃癌中SALL4、GPC3和AFP的表达,分析GCED的临床病理学特征,比较GCED和非GCED(非伴有肠母细胞分化的胃癌)的临床病理特征间的差异。结果 GCED发病率为10.8%(41/377)。41例GCED患者发病年龄39～80岁,平均64.8岁;男性33例,女性8例,男女比约4∶1;肿瘤最大直径1.5～18 cm,平均5.53 cm;早期胃癌3例,进展期胃癌38例。GCED呈管状、乳头状、筛状和实性片巢状,肿瘤细胞立方形、柱状或多角形,核圆形,胞质透亮或嗜酸。SALL4、GPC3和AFP阳性率分别为53.7%、53.7%和80.5%。与非GCED相比,GCED具有更高的脉管侵犯、淋巴结转移率和更高的病理分期(P<0.05),而发病年龄、性别、部位、浸润深度及神经侵犯等差异无显著性(P>0.05)。GCED...

Clinicopathological analysis of gastric adenocarcinoma with enteroblastic differentiation

Purpose To explore the clinicopathological characteristics,diagnosis and differential diagnosis of gastric adenocarcinoma with enteroblastic differentiation(GCED)and to improve the understanding and diagnostic ability of pathologists on GCED.Methods The expressions of SALL4,GPC3 and AFP in 377 gastric cancers were detected by EnVision stain.The clinicopathological morphology of 377 cases of gastric canceRfrom were analyzed retrospectively and the differences of clinicopathological features between GCED and non-GCED were compared.Results The morbidity of GCED was 10.8%(41/377).Among the 41 cases of GCED,the age of onset was 39 to 80 years old(mean 64.8 years),33 cases were males and 8 cases were females,the ratio of male to female was about 4 to 1,the maximum diameteRof tumoRwas 1.5 cm to 18 cm with the average of 5.53 cm,3 cases were early gastric canceRand 38 cases were advanced gastric cancer.Histologically,GCED was predominantly arranged in tubular,papillary,cribriform,solid sheet and nest and tumoRcells were cuboidal,columnaRoRpolyhedral with round nucleus,cleaRoReosinophilic cytoplasm.By immunohistochemical,the positive rates of SALL4,GPC3 and AFP were 53.7%,53.7%and 80.5%.Compared with non-GCED,GCED had higheRvasculaRinvasion and lymph node metastasis probability and higheRpathological stage(P<0.05).But there was no significant difference in age,sex,location,depth of invasion and nerve invasion(P>0.05).In Lauren classification,GCED was mostly intestinal type and mixed type.The serum AFP level in GCED patients was significantly higheRthan that in non-GCED patients(P<0.05).Conclusion Gastric adenocarcinoma with enteroblastic differentiation is a rare malignant tumoRwith unique clinicopathological features and it has more aggressive clinical and biological behaviors compared with non-GCED.