SALL4在消化道肝样腺癌中的表达

Expression of SALL4 in digestive tract hepatoid adenocarcinoma

目的探讨SALL4在消化道肝样腺癌中的表达。方法收集西京医院2015—2018年诊断为肝样腺癌15例患者的临床资料,并进行组织形态学观察、免疫组织化学染色及随访,结合相关文献分析其临床病理特征及预后。结果15例肝样腺癌患者,14例为男性,平均年龄59岁,主要发生于胃窦及贲门、胃体部。12例患者同时发现脉管侵犯及淋巴结转移,5例患者转移至肝脏。术前患者血清AFP水平仅2例升高。镜下同时具有腺癌区域和肝样分化区域,肝样分化区域形态类似肝细胞癌,肿瘤细胞体积大,胞质丰富,呈实性或梁索状排列,并可见丰富的血窦。上述病例均不同程度的表达AFP(4/15)、Hepatocyte(9/15)和Glypican-3(8/15)。进一步研究发现SALL4在15例肝样腺癌中有8例阳性表达,而对照组10例肝细胞肝癌仅1例灶性表达,差异显著。所有病例平均随访18个月,2例死亡,4例失访,中位生存期13个月。结论肝样腺癌具有恶性程度高、侵袭性强和预后差的特征,SALL4在肝样腺癌中的表达率明显高于原发性肝细胞癌,在两者的鉴别诊断中有重要作用。

Objective To explore the expression of SALL4 in digestive tract hepatoid adenocarcinoma(HAC).Methods The clinical data,pathological features and immunohistochemical staining findings of fifteen cases of HAC were reported at Xijing Hospital from 2015 to 2018.Results In fifteen patients with HAC,14 were males,with an average age of 59 years.It mainly occured in the antrum of the stomach,the cardia,and the body of the stomach.12 patients were found to have vascular invasion and lymph node metastasis,and 5 patients had invasion to the liver.Before operation serum AFP levels only increased in 2 cases.Macroscopically,tumors consisted of glandular and hepatoid components.The hepatoid cancer cells were arranged in a solid or trabecular pattern,separated by plentiful sinusoid-like blood vessels.Immunohistochemically,the tumor was positive for AFP(4/15),Hepatocyte(9/15)and Glypican-3(8/15).It was worth noting that further studies found that SALL4 was positively expressed in 8 of 15 cases of hepatioid adenocarcinoma,while in the control group,only 1 of 10 cases of hepatocellular carcinoma was focally expressed,both of which were statistically significant.The average follow-up was 18 months,2 patients died and 4 patients were lost to follow-up.The median survival time was 13 months.Conclusions Hepatoid adenocarcinoma is a rare carcinoma with highly malignant,more aggressive and a poor prognosis.SALL4 has a higher expression rate in HAC than hepatocellular carcinoma,and it plays an important role in the differential diagnosis.