原发性鼻腔鼻窦腺癌15例临床病理分析

Clinicopathological features of primary adenocarcinoma of the nasal cavity and sinuses in 15 cases

目的探讨原发性鼻腔鼻窦腺癌的临床特征及病理诊断要点。方法对15例原发性鼻腔鼻窦腺癌病例重新切片行HE及免疫组化染色,并复习相关文献。结果15例患者年龄范围36~82岁(平均51.9岁),其中男性9例,女性6例,6例为肠型腺癌(intestinal-type adenocarcinoma,ITAC),9例为非肠型腺癌(non-intestinal-type adenocarcinoma,non-ITAC)。临床表现与慢性鼻炎、鼻窦炎症状类似。胃肠检查未见肿瘤。6例ITAC中,包括结肠型4例、乳头状型1例、黏液型1例。9例non-ITAC中,低级别7例,高级别2例。ITAC病例CK20及CDX-2均为阳性,non-ITAC病例全部表达CK7,不表达CDX-2及Villin。结论原发性鼻腔鼻窦腺癌少见,就诊时多为中晚期,ITAC具有肠道分化特征,诊断时需注意与转移性结直肠腺癌鉴别,而non-ITAC的诊断属于排它性诊断,需要先排外其他肿瘤。

Objective To investigate the clinical features and pathological diagnosis of primary sinonasal adenocarcinoma.Methods We performed hematoxylin-eosin(HE)and immunohistochemical staining on 15 cases of primary nasal and paranasal adenocarcinoma,and reviewed relevant literature.Results The 15 cases ranged in age from 36 to 82 years(mean,51.9 years),including 9 males and 6 females,6 with intestinal-type adenocarcinoma(ITAC),and 9 with non-intestinal-type adenocarcinoma(non-ITAC).The clinical manifestations are similar to those of chronic rhinitis and sinusitis.Gastrointestinal examination showed no tumor.Among the 6 cases of ITAC,there were 4 cases of colonic type,1 case of papillary type and 1 case of mucinous type.There were 9 cases of Non-ITAC,7 were low-grade and 2 were high-grade.Both CK20 and CDX-2 were positively expressed in ITAC.All non-ITAC cases expressed CK7,but not CDX-2 and Villin.Conclusion Primary adenocarcinoma of the nasal cavity and paranasal sinuses is rare,and it is mostly advanced at the time of discovery.ITAC has the characteristics of intestinal differentiation and needs to be distinguished from metastatic colorectal adenocarcinoma during diagnosis,while the diagnosis of non-ITAC is an exclusive diagnosis,and other tumors need to be excluded first.