伴有多向分化成分的食管息肉样癌3例并文献复习

Polypoid esophageal carcinoma with neuroendocrine glandular, squamous and sarcomatous components

目的 探讨伴神经内分泌癌、腺癌的食管息肉样癌的病理特点和来源。方法 应用常规病理、免疫组化研究 1例伴神经内分泌癌分化和 2例伴腺癌分化的食管息肉样癌并复习相关文献。结果 肿瘤大体呈息肉状。镜检 1例见大量巢团状排列的小圆形细胞 ,神经内分泌癌成分位于肉瘤样癌之间 ,神经内分泌癌成分chromogranin、NSE(+) ,鳞状上皮黏膜间可见角化的鳞状细胞癌 ;2例伴腺癌成分的食管息肉样癌 ,局部呈腺管状排列 ,鳞状细胞癌和腺癌CK(+) ,肉瘤样成分见多形性梭形细胞 ,核分裂及异型明显 ,α SMA(+) ,CK(- )。结论 伴神经内分泌癌、腺癌的食管息肉样癌罕见 。

Objective To explore the pathological characteristics and histogenesis of polypoid esophageal carcinoma (PEC) with neuroendorine and glandular components. Methods One case of PEC with neuroendocrine differentiation and two with glandular differentiation were studied with conventional histopathologic and immunohistochemical stains. Results The tumors formed lobulate polypoid masses. Microscopically, the neuroendocrine component consisted of sheets or nests of small , round cells separated by bands of sarcoma cells. The neuroendocrine areas expressed chromogranin and NSE. The squamous carcinoma was presented in adjacent squamous mucosa. The adenocarcinoma component showed a tubular structure. Both the squamous cell carcinoma and adenocarcinoma stained positive for cytokeratin. The sarcomatous component contained a pleomorphic spindle cell proliferation. Many tumor cells were huge in size, with bizarre nuclei and abnormal mitoses, and expressed α-SMA, but not cytokeratin. Conclusions PEC with neuroendocrine and glandular components is extremely rare. This tumor seems to derive from the multi-potential stem cell, supporting the metaplastic theory.