食管基底细胞样鳞癌

Basaloid Squamous Cell Carcinoma of the Esophagus

目的 探讨食管基底细胞样鳞癌 (BSCC)的临床病理特点及鉴别诊断。方法 回顾分析 1876例食管鳞癌手术切除病例的临床资料 ,其中 9例诊断为BSCC ,对其临床资料及病理特点进行总结、分析。结果 食管BSCC主要发生于 5 0岁以上男性的中段食管 ,占食管鳞癌的 0 .48%。平均生存 17.6个月 ,2年生存率 2 2 .2 % ,与低分化鳞癌 ( 2年生存率 2 8.3 % )接近。形态学与腺样囊性癌 (ACC)或小细胞未分化癌 (SCC)有相似之处。 9例病例均可见癌与表面粘膜上皮移行过程 ,移行处粘膜上皮呈不典型增生、原位癌或鳞状上皮浸润癌。免疫组化染色与电镜检查有助于鉴别诊断。结论 食管BSCC为 1种形态特殊的高度恶性的鳞状细胞癌。

Objective To evaluate basoloid squamous cell carcinoma(BSCC) of the esophagus on the characteristics of clinico pathology and on the differentiated diagnosis.Methods 9 cases of BSCC were diagnosed from 1876 cases of esophageal squamous carcinoma(0.48%).Their clinicopathologic features were studied.In addition,immunohistochemical features were also investigated,to determine whether this type of carcinoma could be differentiated from adenoid cystic carcinoma(ACC) and small cell undifferentiated carcinoma(SCC).Results All of the cases in our series were eldly males,with a mean age of 59 years.Dysphagia was the main complaint.The tumors were mainly localized at the middle third of esophagus and had poor prognosis with a mean surviving time of 17.6 months.The histopathologic features of this tumor were solid growths of basaloid cells in a lobular configuration,with microcystic patters and stromal hyalinosis as well as palisading of cells.The foci of coagulative necrosis within the central areas of the tumor lobules were found,the mitotic rates were increased as well.Another major feature was the intimate association with surface epithelium including dysplasia,squamous cell carcinoma in situ and focal invasive squamous cell carcinoma.Immunohistochemistry would be helpful for differential diagnosis with ACC and SCC.Conclusion BSCC is a high malignant squamous cell carcinoma that should be distinguished from ACC and SCC.