胃肠道杯状细胞腺癌临床病理分析

Clinicopathological analysis of goblet cell adenocarcinoma of digestive tract

目的:深入探讨胃肠道原发性杯状细胞腺癌的临床特点、病理学特征、分级系统及预后。方法:收集首都医科大学附属北京世纪坛医院病理科2017年12月—2020年12月诊断为胃肠道原发印戒细胞癌或杯状细胞腺癌的376例患者的手术病理切片,由2位具有高级职称的病理科医师进行独立阅片。根据2019版WHO对阑尾杯状细胞腺癌(goblet cell adenocarcinoma,GCA)诊断标准,筛选出阑尾GCA 11例、结肠GCA 4例、胃GCA 1例,分别进行CD56、CgA、Syn、MUC、CDX2、SATB2和Ki-67免疫组织化学染色。结果:11例阑尾GCA患者中,男性8例、女性3例,中位年龄为53岁(范围:15~88岁),均出现多器官转移,其中10例伴腹膜种植。4例结肠GCA患者中,男性2例、女性2例,中位年龄为49岁(范围:47~69岁)。1例胃GCA患者为女性,年龄65岁。组织学形态:肿瘤细胞由黏附性生长的杯状细胞、印戒样细胞或新月核细胞组成,细胞核多位于细胞一侧,核异形大小不等。异形显著者,核不规则,染色质凝集;轻度异形者,核呈新月状,细胞质丰富,富含黏液或胞浆透亮。免疫组织化学检测结果:阑尾GCA中,Syn(72.7%)和CgA表达率(63.6%)高于CD56(45.5%);结肠GCA与胃GCA的Syn、CgA和CD56表达率无明显差异;SATB2在阑尾GCA中的表达率为81.8%,高于结肠GCA和胃GCA组;MUC6在胃、阑尾、结肠GCA中的表达率分别为100.0%、27.3%和0.0%。结论:胃肠道GCA以阑尾最多见,也可以发生于结肠和胃。SATB2和MUC6对寻找GCA原发灶有一定的价值。由于GCA的组织学异质性,需要通过准确评估组织学类型和肿瘤分级,以进一步研究适当的治疗方法。

Objective:This study aims to explore the clinical and pathological features,grading system and prognosis of goblet cell adenocarcinoma(GCA)of the gastrointestinal tract.Methods:According to the diagnostic criteria of WHO Classification of 2019 for GCA of appendix,a total of 376 cases of signet ring cell carcinomas or GCA of gastrointestinal tract were recruited in Department of Pathology,Beijing Shijitan Hospital Affiliated to Capital Medical University from December 2017 to December 2020.Eleven cases of appendix GCA,4 cases of colon GCA and 1 case of stomach GCA were collected by two senior pathologists independently.Results:There were 8 male patients and 3 female patients with appendix GCA,and the median age was 53 years(15-88 years).Among the 11 cases of the appendix,all patients had multi-organ metastases and 10 patients had peritoneal implants.There were 2 male patients and 2 female patients with colon GCA,and the median age was 49 years(47-69 years).The only one case of stomach GCA was a 65-year-old woman.Histological morphology showed the tumor cells included goblet cells with adherent growth,signet ring cells or crescent cells.Cell nuclei were mostly located on the one side,with varying nuclear atypia.Those with marked nuclear atypia had irregular nucleus and chromatin condensation;while those with slight atypia were crescent-shaped,and had abundant cytoplasm and mucus or clear cytoplasm.Immunohistochemistry showed the expression rates of Syn(72.7%)and CgA(63.6%)in GCA of the appendix were significantly higher than CD56(45.5%).There were no significant differences in the expression rates of Syn,CgA and CD56 in cases of the colon and stomach GCA.The expression rate of SATB2 in GCA of the appendix(81.8%)was significantly higher than those of colon GCA and stomach GCA.In addition,the expression rates of MUC6 in GCA of appendix,colon and stomach were 100.0%,27.3%and 0.0%,respectively.Conclusion:GCA of the gastrointestinal tract occurs in appendix mostly,it also occurs in colon and stomach.SATB2 and MUC6 are the important markers to identify the primary site of GCA.Due to the histological heterogeneity of GCA.It is necessary to further study the appropriate treatment by accurately evaluating the histological type and tumor grade.