小肠癌中内分泌型癌细胞的表达及其意义的研究

Study on the expression of neoplastic endocrine cells in the small intestine carcinomas and its significance

目的 对小肠癌中内分泌型癌细胞 (neoplasticendocrinecell,NEC)及其激素产物的表达情况进行研究 ,探讨小肠癌内分泌分化方向与其生物学行为之间的关系。方法 以嗜铬素A作为NEC的标志物 ,应用目前最先进的免疫组化方法 (SP法 )对 70例小肠癌 (十二指肠癌 4 8例 ,空肠癌 10例 ,回肠癌 12例 )进行嗜铬素A及 5种激素抗体的染色。结果 3 9例 ( 5 5 .7% )具有NEC ;5种激素的阳性率分别为血清素 3 8.6% ,生长抑素 3 2 .9% ,胰高糖素 15 .7% ,胃泌素 10 .0 % ,血管活性肠肽 14 .3 %。NEC的分布与小肠癌的发生部位无关 ,而与分化程度及转移有关 (P <0 .0 5 ) ,同时多激素表达与低分化小肠癌相关 (P <0 .0 5 )。结论 多数小肠癌具有不同种类和数量的NEC ,NEC阳性的小肠癌一般分化较差 ,易于发生转移 ;同时低分化小肠癌倾向于多种激素的表达。

Objective To elucidate the pathological and biological significances of endocrine differentiation present in small bowel cancer. Methods Chromogranin A (CGA) was used as the marker of neoplastic endocrine cell (NEC) in 70 small bowel cancers including 48 duodenal, 10 jejunal and 12 ileal cancers. The expression of CGA and five gut hormones in these tumors were immunohistochemically investigated with the update SP method. Results CGA positive endocrine cells were shown in 39(55.7%) tumors. Serotonin positive cells were found in 27(38.6%) cancers, somatostatin in 23 (32.9%), gastrin in 7(10.0%), glucagon in 11(15.7%), and VIP in 10(14.3%), respectively. Multiple immunoreactive cells were present most frequently in poorly differentiated cancers, not relevant to originative site. The NEC population was higher in poorly differentiated tumors than in those well differentiated. Conclusions NEC can be found in more than half of the small intestine carcinomas, and the tumors with NEC tend to be poorly differentiated and more vulnerabe to metastasis. There is a tendency of multiple hormone expression in small bowel cancers with more aggressive behavior.