十二指肠原发性腺鳞癌临床病理观察

Primary adenosquamous carcinoma of duodenum: a clinicopathologic analysis

目的探讨十二指肠原发性腺鳞癌病理学特征及其诊断、治疗。方法对1例十二指肠原发性腺鳞癌行组织病理学检查,并结合文献讨论。结果肿瘤紧邻十二指肠乳头,大小4.5 cm×3.5 cm。镜检:肿瘤由分界清楚、形态典型的多角形鳞状细胞和腺癌细胞组成,癌巢内可见坏死组织。肿瘤细胞侵犯十二指肠全层,其中黏膜层和黏膜下层以腺癌成分为主,而肌层和浆膜层则主要是鳞状细胞癌,胰腺周围淋巴结见鳞状细胞癌成分转移,胰腺内亦可见到鳞状细胞癌成分,而其余组织均未见肿瘤成分。结论十二指肠腺鳞癌是一种少见的恶性肿瘤,具有明确的形态学特征,即肿瘤由腺癌和鳞癌成分共同组成,且每种形态超过肿瘤的1/3。

Objective To study the clinical pathological features, diagnosis and treatment of duodenal adenosquamous carcinoma. Methods A case of duodenal adenosquamous carcinoma was investigated by light microscopy, and the literature was reviewed. Results The tumor was close to the duodenal papilla. The tumor was 4. 5cm × 3.5cm in size. Microscopy showed that resected specimen consisted of well-demarcated nests of large typical polygonal squamous cells and smaller adenocarcinoma cells grouped around necrotic tissue, with the former being predominant. The tumor had infiltrated the entire duodenum wall, showing poorly differentiated squamous cell carcinoma and adenocarcinoma; in the mucosa and submucosa adenocarcinoma was predominant, and in muscularis and serosa was squamous cell carcinoma; ulcer was mainly constituted by adenocarcinoma, and the peripancreatic lymph nodes and pancreas was also invaded by squamous cell carcinoma. Conclusion Primary adenosquamous carcinoma of duodenum is a rare malignant tumor, with clear morphological characteristics, and it is composed of adenocarcinoma and squamous cell carcinoma, each form of more than 1/3 of the tumor.