10例食管基底细胞样鳞癌的临床病理及免疫组化研究

Esophageal Basaloid Squamous Carcinoma A Clinicopathologic and Immunohistochemical Study of 10 Cases

目的 研究食管基底细胞样鳞癌病理特征 ,探讨其病变性质、诊断及鉴别诊断。方法 应用形态学、组织化学 (AB/PAS)和免疫组织化学方法 (S P法 ) ,对 10例男性食管BSC患者进行病理形态学观察和多种抗体免疫组织化学检测。结果 癌瘤显示基底细胞和鳞状细胞双相型癌肿成分。基底细胞样癌多呈实体分叶状 (10 0 .0 % )、巢索状 (80 .0 % )、指突状 (5 0 .0 % )、巢周栅状 (90 .0 % )排列 ,巢中央有特征性粉刺型坏死 (80 .0 % ) ,间质有基膜样物质沉积和玻璃样变 (80 .0 % )。鳞状细胞样癌呈原位癌、片状、单个细胞角化或角化珠镶嵌于基底细胞样癌中 ,易见脉管瘤栓 (80 .0 % )和核分裂像 (35～ 10 0个 /10HPF)。多数病例免疫组织化学Ki 6 7、PCNA、CK (AE1/AE 3)、CK 14、CK 19呈阳性表达 ,SC、CHG A、Syn、S 10 0 、α SMA则多呈阴性表达 ,但缺乏诊断特异性。结论 食管BSC系鳞癌的 1种特殊亚型 ,其生物学行为具有与低分化鳞癌相似或更强的侵袭行为和更差的预后特征。

Objective To study the pathological feature of esophageal basaloid squamous carcinoma(BSC) and explore the diagnosis and differential diagnosis of the tumor.Methods Morphology,histochemistry(AB/PAS) and S-P immunohistochemical methods were used for study of 10 cases of BSC.Results It showed that these tumors were composed of both basaloid cells and squamous cells.BSC arranged in solid lobules(100.0%),nests or cords(80.0%),fingerlike(50.0%).The cells around the carcinoma nests arranged in palisade(90.0%);comedo-like necrosis(80.0%) was present in the center of the nests,hyaline degeneration (80.0%) was found within the stroma of the tumor.The components of the squamous carcinoma cells showed carcinoma in situ,or in solid masses or single keratinized cells or keratinized pearls intermingled within the basaloid cells carcinoma.It was easy to find cancer emboli(80.0%) in vessels and mitotic figures(35～100 per 10 high power fields).The tumor cells exhibited positive for Ki-67,PCNA,CK(AE1/AE3),CK14,CK19,and negative for SC,CHG-A,Syn,S-100,α-SMA,but their specificity was lacking for diagnosis.Conclusion Esophageal BSC is a distinctive sub-type of the squamous cell carcinoma(SCC),its biological behavior is more extremely aggressive behavior and more poorly prognosis than the low differentiated squamous cell carcinoma or sometimes similar to SCC.