胃癌新辅助化疗后原发灶病理完全缓解患者的病理学观察

目的观察胃癌新辅助化疗后原发灶病理学完全缓解（pCR）患者的病理学特征。方法收集北京肿瘤医院2002-2008年间完成新辅助化疗的胃癌患者病例资料．筛选出原发灶pCR者共5例。复习病理切片,并分别就胃壁的组织结构、肿瘤细胞形态、间质细胞的数量和形态进行分析评价。结果5例患者胃壁结构均可区分,有2例可见肌层弯折、断裂。1例可见胃壁各层包括浆膜层呈现渗出性炎性表现。3例溃疡型病变,上皮层脱落,溃疡存在,边缘可见不典型增生的细胞改变,间质血管内皮细胞肿胀。仅1例残留变性坏死的癌细胞,其余4例未见癌残留迹象。4例显示成纤维细胞显著增生,3例见大量淋巴细胞浸润。1例同时伴有浆细胞浸润,1例肌层可见多核巨细胞反应,1例黏液腺癌可见泡沫细胞聚集。5例原发灶pCR病例中有2例淋巴结可见癌转移。结论胃癌新辅助化疗后,原发灶pCR病例肿瘤区域间质细胞反应呈现不均一性,原发灶反应与淋巴结不相一致。

Clinicopathological observation of gastric cancer with pathological complete response following neoadjuvant chemotherapy

Objective To observe the clinicopathological characteristics of gastric cancer with pathological complete response(pCR) following neoadjuvant chemotherapy. Methods Data of gastric cancer patients who received neoedjuvant chemotherapy from 2002 to 2008 in the Beijing Cancer Hospital were reviewed. Five cases were found to have pCR. The slides were reviewed by two experienced pathologists independently. Histological structure, morphology of tumor cells, morphology and quantity of stromal cells were evaluated. Results Structure of the gastric wall was distinguishable in all the 5 cases, while distortion and rupture of muscular layer were found in 2 cases. Exudative inflammatory reaction was present in the whole gastric wall including the serosa layer. Three patients had ulcerative lesions with epithelial layer shedding, and atypical hyperplasia was found around the border of the ulcer, and vascular endothelial cells were swollen. Residual distorted necrotic tumor cells resided in 1 case only and no residual tumor cells was present in the other 4 patients. Significant hyperplasia of fibroblasts was present in 4 cases, large amount of lymphocytes infiltration in 3 cases including concurrent plasma cell infiltration in 1 case, multinucleated giant cell reaction in the muscular layer of 1 case, and foam cells aggregation in 1 case with mucinous adenocarcinoma. In addition, there were 2 cases with pCR had lymph node metastasis. Conclusions For cases with pCR following neoadjuvant chemotherapy, heterogeneity of stromal cells reaction is found in previous tumor site. Furthermore, the response of primary tumor does not necessarily parallel to that of lymph nodes.