阑尾杯状细胞类癌临床病理分析

Goblet cell carcinoid of the appendix: a clinicopathological analysis of 3 cases

目的探讨阑尾杯状细胞类癌(GCC)的组织学来源、临床病理特点和生物学行为。方法采用光镜结合免疫组织化学标记对3例阑尾GCC进行研究。结果3例阑尾GCC均为男性。镜检肿瘤主要由杯状细胞构成,内含黏液,核位于一侧,无明显异型性,以单个、小巢或腺泡状结构排列,腺泡中央无腔隙,1例由纯杯状细胞构成,2例可见散在典型类癌成分,呈小梁、小管状结构,小管状与杯状细胞间及杯状细胞与隐窝上皮间有移行现象,但阑尾腔表面黏膜未见侵犯。免疫组织化学标记CgA,Syn,CEA,CK均阳性,p53阳性1例。结论阑尾GCC由散在的神经内分泌和黏蛋白分化的多潜能细胞分化而来,是阑尾类癌的一种亚型,诊断主要依靠常规病理、免疫组织化学的综合观察,生物学行为难以预测,可能和肿瘤组成成分及浸润程度有关。

Objective To investigate the histogenesis, clinicopathological features and biological behavior of goblet cell carcinoid （GCC） of the appendix. Methods 3 cases of GCC of the appendix were studied by light microscopy and immunohistochemistry. Results 3 cases all occured in men. Microscopically： the tumor was composed of goblet cells containing mucin-filled with basal round to crescentic nuclei without atypia. These tumor cells were arranged in single forms, nests or acinus with no central lumen. 1 case was composed of simple goblet cells and typical carcinoid cells were seen in other 2 cases arranged in trabeculae and tubule. There was transition between goblet cells with tubelar and crypt epithelium. Immunohistochemical staining revealed that goblet cells were positively reacted with CgA, Syn, CEA, CK and p53 in 1 case. Conclusions Goblet cell carcinoid of the appendix arise from a pluripotent cell with divergent neuroendocrine and mucinous differentiation. It is a subtype of carcinoids of the appendix. The diagnosis mainly bases on its morphologic changes and immunohistochemical findings. The unpredictable behavior of this tumor is probably related to its component and the degree of infiltration.