小肠肉瘤样癌临床病理分析

目的探讨小肠肉瘤样癌的临床病理学特点及免疫组织化学表型。方法采用光镜结合免疫组化SP法对6例小肠肉瘤样癌标本进行观察分析。结果6例小肠肉瘤样癌患者中男性5例，女性1例；年龄43～72岁，平均61．3岁。肿瘤平均直径为5．5cm。呈菜花状或息肉状。光镜下可见3种肿瘤细胞：上皮样细胞、梭形细胞及间变性细胞，多呈片状或束状排列，偶呈巢状排列。免疫组化显示：6例vimentin、CKpan、EMA及CK7均为强阳性；CK20有两例弱阳性；CEA有1例弱阳性；NSE及Syn在6例均为阳性表达，CgA3例阳性，阳性强度为弱阳性～中等阳性；Ki-67阳性指数为37％～73％，平均值为51．6％。随访4例患者在术后2～7个月内死亡。结论小肠肉瘤样癌罕见，多发于老年男性，免疫组化证实有上皮及神经内分泌分化，预后很差，免疫组化在鉴别诊断中很重要。

Clinicopathologic features of sarcomatoid carcinoma in small intestine

Purpose To study the clinicopathological and immunohistochemical features of sarcomatoid carcinoma arising from the small intestine. Methods Six cases of sarcomatoid carcinoma of the small intestine were investigated by light microscopy and immunohistochemistry of SP method. Results The patients were five males and one female, aged from 43 to 72 (mean 61.3) years. The size of the tumors ranged from 3.0 cm to 8.5 cm in diameters (mean 5.5 cm), and all tended to grow as cauliflower or polypoid masses. Microscopically, epithelial cells, spindle cells and anaplastic cells were found mostly arranged in sheets and fascicles, uncommonly in nets. Immunohistochemically, vimentin, CKpan, EMA and CK7 were strongly positive in all 6 cases. Weak reactions of CK20 and CEA were found in 2 cases and 1 case respectively. Weak and moderate reactions of NSE and Syn were found in all 6 cases, and CgA in 3 cases. Ki-67 proliferating index of the tumor cells ranged from 37% to 73% (mean 51.6%). 4 patients with clinical follow-up died of metastasis or/and recurrence within 2 and 7 months.Conclusions Sarcomatoid carcinoma of the small intestine is a rare neoplasm frequently occurred in old male adults. The epithelial and neuroendocritic differentiations were identified by immunohistochemistry. The prognosis is very poor. Immunohistochemistry play an important role in the differential diagnosis.