普通型胃癌伴神经内分泌分化的免疫组织化学观察

目的研究普通型胃腺癌组织学类型、分化程度与神经内分泌（NE）分化的关系.方法随机收集88例手术切除石蜡包埋的胃癌标本,采用Syn、CgA及NSE等3种神经内分泌抗体,用免疫组织化学方法研究其神经内分泌的表达情况.结果在88例普通型胃癌中,38例（43.2%）表达Syn,13例（14%）表达CgA,10例（11%）表达NSE.58例（65.9%）至少有一种NE标记表达,其中18例表达2种标记,仅4例3种标记均表达,3种标记表达彼此相关（P＜0.05）.胃癌中以低分化腺癌、黏液腺癌、印戒细胞癌阳性多见（P＜0.05）.NE阳性与肿瘤大小和浸润深度有关（P＜0.05）,但是NE标志阳性与淋巴转移及临床分期差异无统计学意义（P＞0.05）.结论选择3种NE标记可以检测出胃癌的NE分化,三者联合应用可提高NE分化的诊断率.胃癌的组织类型、分化程度及肿瘤大小和浸润深度与NE分化有关,而NE分化与淋巴结转移及临床分期无关.

An Immunohistochemical Observation of General Gastric Carcinoma with Neuroendocrine Differentiation

Objective To explore the correlation of the histological type,differentiation degree and neuroendocrine differentiantion in general gastric carcinoma.Methods 88 general gastric carcinomas,which were embedded with paraffin after gastrectomy,were randomly collected.The protein expression levels of synaptophysin(Syn), chromogranin A(CgA) and neuron specific enolaes(NSE) in the above cancers were studied under microscopy by method of immunohistochemistry. Results Syn,CgA and NSE were observed in 38(43.2%), 13(14%) and 10(11%) of the whole 88 gastric cancers respectively. It was also found that at least one antibody expressed in 58(65.9%),2 antibodies were positive in 18 while 3 positive in only 4 cases of the 58 cases.All of the three antibodies were related to each other (P<0.05).Most types of the positive cases were poorly differentiated adenocarcinoma,mucinous adenocarcinoma and signet ring cell carcinoma(P<0.05). The expression of neuroendocrine had significant relation with the size of neplasms and the depth of invasion (P<0.05),while it had relation with neither the meastasis of lymph node nor the clinical stage(P<0.05). Conclusion Neuroendocrine differentiation is correlated with histological type, degree of histological differentiation, size of neoplasm and depth of invasion, while it has no relation to metastasis of lymph node and clinical stage.