食管基底细胞样鳞状细胞癌临床病理研究

Basaloid squamous cell carcinoma in the esophagus: A clinicopathological study

目的 探讨食管基底细胞样鳞状细胞癌 (BSCC)的临床病理特征及诊断标准。方法 收集 5例食管BSCC分别作HE、组织化学及免疫组化染色 ,其中 2例作电镜观察。结果 BSCC主要由密集的小细胞组成 ,排列成实体小叶状及筛网状 (假腺样 ) ,并见粉刺样坏死、玻璃样变性及基底膜样物质沉积 (PAS + ) ,4例BSCC均见不同分化程度的鳞状细胞癌成分 ,1例见局灶性鳞状细胞分化。免疫组化Ker(AE1/AE3 )、Ker14、LM、PCNA及p5 3均阳性 ,4例Ker19阳性 ;仅见 1例Syn阳性 ;S 10 0、CgA、NSE及SMA阴性。 2例BSCC超微结构可见鳞状细胞分化及基底膜样物质沉积。患者发病年龄大 ,首次手术多数可见区域淋巴结转移 ,1例转移至肺 ,术后 2个月死亡 ;4例随访无结果。结论 BSCC是鳞状细胞癌独特的组织学类型 ,分化低 ,预后较差。

Objective To study the clinical pathological characteristics and diagnostic criteria of basaloid squamous cell carcinoma (BSCC) of the esophagus. Methods Hematoxylin-eosin, histochemical and immunohistochemical stains were used in 5 cases of BSCC of the esophagus, two of them analyzed by electron microscope. Results BSCCs were composed of relatively small tumor cells, arranged in solid lobules, or cribriform (psudoglandular spaces) with abundant comedo-type necrosis, hyaline degeneration and basal membrane-like material with PAS+ stroma. Areas of typical squamous cell carcinoma (SCC) were found in four cases. Immunohistochemically, Ker (AE1/AE3), Ker14, ker19, laminin, PCNA and p53 were positive in all cases. Ker19 expressed in 4 cases and synaptophysin in one case. S-100, chromogranin, neuron specific endolase and smooth muscle actin were negative in the tumors. Ultrastructural characterization of two BSCC cases revealed features of squamous cell differentiation in basaloid cell areas and peculiar basal membrane-like materials. BSCCs commonly occurred at older patients and were highly malignant tumors. Metastasis into the regional lymph nodes was usually found at the first operation. One of them died in two months after operation. Conclusion BSCC is a distinct histopathologic variant of SCC, with a poorer prognosis than that of the conventional SCC.