乙状结肠锯齿状腺癌伴异位骨化生1例临床病理特征及文献复习

Clinicopathological characterization of serrated adenocarcinoma with heterotopic ossification in the sigmoid colon and literature review

目的探讨乙状结肠锯齿状腺癌伴异位骨化生l例的临床病理特征及意义。方法回顾性分析1例乙状结肠锯齿状腺癌伴有异位骨化生的病例并复习文献。结果病理巨检见肠腔内菜花样肿物,大小4.7cm×3.4cm×3.1cm,切面灰白色、质地偏硬。镜下中分化腺癌具有锯齿状结构,胞浆丰富、呈嗜酸性或嗜中性,有黏液、筛状、花边状和小梁状区域,侵犯深度达浆膜层。肿瘤间质中可见岛状化生骨,周边被覆骨母细胞,骨岛周围见明显成纤维细胞增生及玻璃样变,与成骨细胞移行的现象。肿瘤与相对正常黏膜交界处可见锯齿状腺瘤结构。肿瘤未见出血或坏死,间质中较多淋巴细胞浸润,可见少数淋巴管癌栓,肠系膜淋巴结未见癌转移。免疫组织化学染色显示CEA、CK8/18、CK19、β-catenin和E-cadherin均阳性表达,CK20部分阳性表达,CK7、CDX-2、Vimentin、bcl-2、S-100、CD56、p16均为阴性,Ki-67约为80%阳性。结论肠锯齿状腺癌中异位骨化生只是一个组织学现象,没有临床预后意义,发生的机制尚无确切定论。

bObjective To study the clinicopathological characteristics and significance of serrated adenocarcinoma with hetero- topic ossification in the sigmoid colon. Methods We retrospectively analyzed a case of serrated adenocarcinoma with heterotopic ossifi-cation in the sigmoid colon and reviewed associated literature. Results Gross pathological examination revealed a cauliflower-like mass within the lumen in size 4.7cm X 3 .4cm X 3 . 1cm, the surface of cross section being gray and white with harder texture. The moderately differentiated adenocarcinoma was observed under the microscope with serrated structure and abundant eosinophilic or neutrophilic cyto-plasm. The carcinoma had a focal mucinous component present in cribriform, lacelike and trabecular patterns, invading into the serosa layer. Heterotopic ossification islands were observed in the stroma and surrounded by osteoblasts. Obvious fibroblast proliferation and hyalinization were visible around the heterotopic ossification islands, as well as migration of osteoblasts. Serrated adenoma structure was observed at the boundary of the tumor and relatively normal mucosa. Neither necrosis nor bleeding was detected in the carcinoma re-gions, while infiltration of many lymphocytes was found in the stroma, A few cancer emboli in lymph vessels were observed, but no mesenteric lymphatic metastasis was detected. Immunohistochemical staining showed positive expression of CEA, CK8/18, GK19, p- catenin and E-cadherin, partially positive CK20, negative CK7, CDX-2, Vimentin, bcl-2, S-100, CD56 and pl6, and 80% positive Ki-67. Conclusion The heterotopic ossification in serrated adenocarcinoma is a histological curiosity with no prognostic significance. The pathogenesis of heterotopic ossification is no definite conclusion.