胃淋巴上皮瘤样癌12例临床病理分析

Lymphoepithelioma-like carcinoma in stomach: a clinicopathologic analysis of 12 cases

目的探讨胃淋巴上皮瘤样癌(LELC)的临床病理特点。方法复习307例经手术根治切除的胃癌病理切片,筛选出12例胃LELC(3.9%),总结其临床资料、组织学、免疫表型、EBER原位杂交及随访情况,结合相关文献进行分析讨论。结果 12例胃LELC患者中男性8例,女性4例,平均年龄58岁,发生部位均在近端胃。组织学表现为肿瘤细胞排列成条索状、巢片状结构,部分可见小的腺腔样结构,间质有大量淋巴样细胞浸润。免疫表型示12例肿瘤细胞EMA、CEA和CAM5.2(+),3例CDX-2弱(+),S-100、Syn、CgA和vimentine(-)。原位杂交示9例中癌细胞EBER(+)。随访3个月到5年余,9例无瘤存活,2例死亡(死因不详),1例失访。结论胃LELC是一种罕见的、具有独特临床病理特征的胃癌亚型,大部分病例与EBV感染相关,预后相对较好。

Purpose To study the clinicopathological features of gastric lymphoepithelioma-like carcinoma （LELC）. Methods A total of 307 consecutive gastric carcinoma patients during 2006 to 2012 who underwent potentially curative surgery were retrospectively reviewed and 12 cases （3.9%） were identified as gastric carcinoma with LELC. Clinical data, histologic evaluation, immunophenotype, EBV status and cancer-specific survival were observed, and the related literatures were reviewed. Results Among the 12 cases of gastric carcinoma with LELC, eight cases were men and 4 were women, with the mean age of 58 years. All of the 12 tumors were located in the proximal stomach. Microscopically, tumor cells always arranged in solid sheets or cords and some uniform cavities with a pronounced lymphocytic infiltrate surrounding the cancer cell nests. Immunohistochemieally, all of the 12 cases were positive for EMA, CEA and CAM5. 2, among which 3 cases were weakly positive for CDX-2. Neither of the tumor cells was positive for S-100, Syn, CgA and vimentin. With in situ hybridization, 9 cases （9/12） showed EBER positive in tumor cells. Follow-up information in 11 of 12 patients （3 to 60 months） revealed disease-free survival in 9 patients and two patients died in the follow-up period. Condsions Gastric LELC is a rare and unique subtype of gastric carcinoma, which is often associated with EBV infection and improved patients＇ survival as compared with gastric carcinoma without a significant lymphoid infitrate.