胃原发性浆细胞瘤1例临床病理分析

Clinicopathological characteristics of primary gastric plasmacytoma: report of a case and review of literature

目的探讨胃原发性浆细胞瘤病理学特征及其诊断、治疗。方法对1例胃原发性浆细胞瘤行组织病理学形态观察及免疫组化检测,并结合相关文献进行讨论。结果肿瘤位于胃体部,大小6 cm×5 cm×3 cm,周边散在息肉样肿块,最大者直径6 cm。镜检:肿瘤由具有浆细胞特征的瘤细胞构成,多为成熟的浆细胞,细胞呈圆形或卵圆形,染色质呈车轮状排列,在显微镜高倍视野下可见双核、多核,核分裂象1~2个/HPF,肿瘤细胞弥漫片状排列并侵及胃壁全层。免疫组化PAX-5、CD138、CD38、Pan-CK、EMA、CD30、MUM-1、vimentin和CD10(+);Kappa、Lambda、EBV、EBER、CK7、CD5、CD20、CD56、CD79α、CD4、CD8、CD45、CD43、CD68、S-100、melan-A、HMB45、CD34、CD117、DOG-1、CEA、bcl-6、PAX-8、CD3、ALK、granzyme B和TIA为(-);Ki-67增殖指数80%;D2-40显示脉管内瘤栓形成。结论胃原发性浆细胞瘤较罕见,有关病例报道较少,因缺乏特异性临床表现及影像学依据,极易被误诊,明确诊断依赖于病理学检查,免疫组化有助于鉴别诊断。

Objective To investigate the pathological features,diagnosis and treatment of primary gastric plasmacytoma.Methods A case of primary gastric plasmacytoma was examined by histopathology and immunohistochemistry,and the literature was reviewed. Results The tumor located in the body of the stomach. The tumor was about 6 cm x 5 cm x 3 cm in size,scattered around the ulcer in the polypoid tumor,with the largest diameter of 6 cm. Microscopy showed that the mass was composed of clusters of typical plasmacytoma cells with a spoke-wheel-like nuclei or eccentric nuclei. Occasional bi-and multi-nucleation and 1-2 mitotic figures were observed in per high-power field. The tumor had infiltrated into the entire gastric wall. Diffuse lamellar arrangement of tumor cells was noted. The immunohistochemical findings showed that the tumor cells were positive for PAX-5,CD138,CD38,Pan-CK,EMA,CD30,MUM-1,vimentin and CD10,and negative for Kappa,Lambda,EBV,EBER,CK7,CD5,CD20,CD56,CD79α,CD4,CD8,CD45,CD43,CD68,S-100,MelanA,HMB45,CD34,CD117,DOG-1,CEA,Bcl-6,PAX-8,CD3,ALK,Granzyme B and TIA. The Ki-67 labeling index was high（ about 80%）; D2-40 showed that the formation of intravascular tumor embolus. Conclusion Primary gastric plasmacytoma is rare and few cases have been reported before. This tumor is easily misdiagnosed,because the tumors lack the specific clinical manifestations and imaging; its definitive diagnosis depends on pathological examination, and immunohistochemistry is helpful for differential diagnosis.