胃腺癌伴肠母细胞分化的临床病理学特征及FAT1表达的意义

Clinicopathological features and the significance of FAT1 of gastric adenocarcinoma with enteroblastic differentiation

目的探讨胃腺癌伴肠母细胞分化(gastric adenocarcinoma with enteroblastic differentiation,GAED)的临床病理学特征及FAT1表达的意义。方法采用免疫组化EnVision两步法检测306例胃腺癌中SALL4、Glypican-3、AFP的表达,共诊断42例GAED,分析其临床病理学特征。免疫组化EnVision两步法检测GAED中CD10、CDX2、MUC-2和FAT1的表达,分析各标志物与GAED临床病理学特征的关系。结果GAED与同期普通型胃癌相比,具有更高的淋巴管血管侵犯和转移率,具有多种组织学形态。GAED不同程度表达SALL4、Glypican-3和AFP,三种标志物表达与肿瘤大小、T分期及血管、淋巴管侵犯具有相关性(P<0.05)。GAED中CDX-2高表达,FAT1表达明显降低(P<0.05)。结论GAED是一类侵袭性高、预后差的肿瘤,SALL4和Glypican-3联合检测可以提高诊断率。FAT1在GAED中发挥抑癌基因作用。GAED和肝样腺癌在形态学、免疫表型上有较大重叠性,应规范此类肿瘤的名称。

Purpose To analyze the clinicopathological features of gastric carcinoma with enteroblastic differentiation(GAED)and the expression significance of FAT1.Methods Immunohistochemistry was used to detect the expression of SALL4,Glypican-3 and AFP in 306 cases of gastric adenocarcinoma,and 42 cases of GAED were diagnosed.The clinicopathological characteristics of GAED were analyzed.The expressions of CD10,CDX2,MUC-2 and FAT1 were detected by immunohistochemistry in all cases of GAED,and the relationship between these markers and the clinicopathological characteristics of GAED was analyzed.Results Compared with the common gastric cancer of the same period,GAED had a higher rate of lymphatic vessel invasion and metastasis,and had a variety of histological morphology.GAED expressed SALL4,Glypican-3 and AFP to varying degrees,and the expression of these three markers was correlated with tumor size,T stage and vascular and lymphatic vessel invasion.CDX-2 expression was highly expressed in GAED and FAT1 expression was significantly decreased.Conclusion GAED is a kind of tumor with high aggressiveness and poor prognosis.Correct understanding and diagnosis of this kind of tumor is of great significance to judge the prognosis of patients.SALL4 and Glypican-3 are sensitive markers for the diagnosis of GAED,and the combination of SALL4 and Glypican-3 can improve the diagnostic rate of this tumor.FAT1 acts as a tumor suppressor gene in GAED.GAED and hepatoid adenocarcinoma have a great overlap in morphology and immunophenotype,so the designation of these tumors should be standardized.