食管基底细胞样鳞形细胞癌临床病理研究

目的：进一步阐明少见的食管基底细胞样鳞形细胞癌（BSC）的临床病理学特征。方法：收集21例食管BSC分别作苏木精-伊红（H-E）染色及组织化学、免疫组化染色（S-P法），其中7例作电镜观察，并进行随访。结果：BSC最主要的组织学特征是基底细胞样癌呈实体小叶状、筛网状排列，癌巢中央见粉刺状坏死，并恒伴有鳞形细胞癌或癌巢内伴有小灶性鳞状成分，表面黏膜可伴有异型增生或原位癌。免疫组化染色，肿瘤内的基底样细胞示：细胞角蛋白（CK）14／16（＋），上皮膜抗原（EMA）15／16（＋），波形蛋白（Vimentin）14／16（＋），S-100蛋白7／16（＋），癌胚抗原（CEA）和平滑肌肌动蛋白（SMA）阴性。电镜下示基底样癌细胞分化差，细胞器少，细胞间有少量桥粒，癌细胞梁索间可见特征性的多层折叠或指纹状的基膜。15例获随访结果，其中13例Ⅱ期以上者有10例于手术后2年内死于肿瘤复发或转移。结论：食管BSC是一种新的独立的临床病理类型，因分化低、恶性程度高，预后较差．

Basaloid-squamous carcinoma of the esophagus: a clinicopathologic, immuno-histochemical and electron microscopic study

Objective:To investigate the clinicopathological,immunohistochemical and electron microscopic features of basaloid squamous carcinoma(BSC) of the esophagus. Methods: The clinical and pathological data,and HE stained slides of 21 BSC patients were reviewed.Immunohistochemical stains,histochemical stains,and electron microscopic study were used to further characterize the neoplasm. Results: The most important histologic characteristics of the BSC is carcinoma with a basaloid pattern,intimately accompanied with squamous cell carcinoma,dysplasia,or focal squamous differentiation.The basaloid cells were round to oval in shape with scant cytoplasm,arranged mainly in the form of solid,smooth contoured lobules with peripheral palisading.A panel of immunostains were used for the basaloid component of the tumor with the following results: cytokeratin(pan): 14/16 positive,epithelia membrane antigen(EMA): 16/16 positive,S-100 protein: 7/16 positive,carcinoma embryonic antigen(CEA) and smooth muscle actin were negative.Electron microscopy revealed that the basaloid cells were poorly differentiated,with a few desmosomes and fibrils.There were many basal membrane-like materials filled in the intertrabecular and intercellular spaces.Of the 15 cases with follow-up,10 died of tumor recurrence or metastases within 2 years. Conclusion: The BSC of the esophagus was a distinct clinicopathological entity with poor differentiated and miserable prognosis.