阑尾杯状细胞腺癌20例临床病理分析

Appendiceal goblet cell adenocarcinoma:a cliniopathologic analysis of 20 cases and review of literature

目的杯状细胞肿瘤是一类较为罕见的肿瘤,多见于阑尾。之前的诊断及命名较为复杂且混乱,最新WHO(2019)第五版《消化系统肿瘤组织学分类》将其单独进行分类,且推荐使用阑尾杯状细胞腺癌这一诊断术语。此次我们对既往诊断阑尾杯状细胞类癌的病例进行回顾,按照最新的WHO分类进行组织学分级,并就临床及相关组织学参数进行统计及相关性分析。方法回顾我中心2018-01—2019-11诊断的20例阑尾杯状细胞类癌病例,采用WHO(2019)《消化系统肿瘤组织学分类》标准进行诊断命名及组织学分级,结合免疫组化CgA、Syn、CEA、Ki-67的表达情况及临床相关信息进行分析。结果20例诊断为阑尾杯状细胞腺癌的患者中,组织学分级与年龄及性别无相关性,肿瘤临床分期与性别、年龄及Ki-67指数无相关性,但组织学分级与Ki-67指数呈正相关。结论阑尾杯状细胞腺癌平均Ki-67指数及热点Ki-67指数与组织学分级均呈正相关。因此我们推测Ki-67指数在阑尾杯状细胞腺癌的组织学分级中,起着与胃肠神经内分泌肿瘤(NENs)分级类似重要的作用,这将为病理医生规范诊断该疾病提供了一定的帮助,同时为临床预后的判断及治疗起到了一定的指导作用。

Objective Goblet cell tumor is a relatively rare type of tumor,which is more common in the appendix.The previous diagnosis and naming were complicated and confusing.The appendiceal goblet cell adenocarcinoma is recommended and classified separately according to the latest WHO(2019)Classification of Digestive System Tumors classifies.We reviewed previous cases of appendiceal goblet cell carcinoid,performed histological classification according to the latest WHO classification,and performed statistical and correlation analyses on clinical and related histological parameters.Methods Twenty cases of appendiceal goblet cell carcinoid diagnosed in our center from January 2018 to November 2019 were reviewed for naming,histological grading according to the 2019 WHO"Digestive System Tumor Classification"criteria,combined with immunohistochemical markers(CgA,Syn,CEA,Ki-67)and clinical related information.Results Through statistical analysis,the 20 patients were diagnosed with appendiceal goblet cell adenocarcinoma;we found that there was no correlation between histological grade and age and gender,and no correlation between tumor clinical stage and gender,age,and Ki-67 index,but the histological grade was positively correlated with the Ki-67 index.Conclusion The average Ki-67 index and hotspot Ki-67 index of appendiceal goblet cell adenocarcinoma are positively correlated with histological grade.Therefore,Ki-67 index plays an equally important role in the histological classification of appendiceal goblet cell adenocarcinoma as the basis for the classification of gastrointestinal neuroendocrine neoplasms(NENs).which will help pathologists to diagnose the disease for certain extent,and at the same time it has a guiding role in the judgment and treatment of clinical prognosis.