西藏地区藏族手术切除确诊胃癌病例的病理特征及Her-2、MUC2、EB病毒检测结果分析

Pathological features and detection of HER-2,MUC2 and EB virus in patients with gastric cancer confirmed by surgical resection in Tibet

目的研究西藏地区藏族胃癌患者的临床病理特征,并探讨各个组织学类型特点及Her-2、MUC2免疫组化表达和HER2基因扩增及EB病毒检测情况,为本地胃癌患者个性化的诊疗提供依据,用于胃癌靶向治疗。方法收集近2年西藏自治区人民医院病理科手术切除胃标本,其中共有手术切除胃癌标本34例,收集患者临床及病理资料。全部病例均经Her-2、MUC2免疫组化染色,判读Her-2免疫组化结果为2+及以上的病例进行荧光原位杂交(FISH)检测。全部病例加做EB病毒相关原位杂交(EBER)检测。结果34例手术切除胃癌患者,男∶女=25∶9,年龄33~68岁。显微镜下,5例为早期胃癌,29例为进展期胃癌。组织学分型上,以管状腺癌为主,胃底腺腺癌2例,伴微乳头成分的腺癌2例,混合性腺癌和神经内分泌癌2例。免疫组化方面,15例Her-2为0,8例为1+,7例为2+,4例为3+。19例MUC-2为阳性,15例为阴性。11例进行了HER-2的FISH检测,6例可见阳性信号。EBER检测结果显示4例(12%)为(+),30例为(-)。结论西藏地区藏族胃癌病例组织学类型多样,以60岁以下男性患者为主。MUC2在胃癌组织及肠化腺体中均有较高的表达,尤其是在黏液成分为主的胃腺癌中高表达。EB病毒相关胃癌在西藏地区藏族占比高于内地报道。西藏地区藏族胃癌患者Her-2免疫组化2+及以上结果病例所占比例及HER2基因扩增患者所占比例均高于内地报道,这部分患者有望获益于HER-2靶向治疗。

Objective To study the clinicopathological characteristics of Tibetan patients with gastric cancer,and to explore the characteristics of each histological type,the expression of HER-2,MUC2 immunohistochemistry,HER2 gene amplification and EB virus detection,so as to provide the basis for personalized diagnosis and treatment of local gastric cancer patients.Methods The clinical and pathological data of 34 Tibetan patients with gastric cancer were collected.All cases were subject to HER-2 and MUC2 immunohistochemical staining.The cases with HER-2 immunohistochemical result of 2+and above were detected by fluorescence in situ hybridization(FISH).EBV related in situ hybridization(EBER)was performed in all cases.Results All the 34 patients(male:female=25∶9,aged 33-68 years)underwent surgical resection of gastric cancer.Microscopically,5 cases were early gastric cancer,and 29 cases were advanced gastric cancer.Histologically,tubular adenocarcinoma was the main type,gastric fundus adenocarcinoma in 2 cases,micropapillary adenocarcinoma in 2 cases,mixed adenocarcinoma and neuroendocrine carcinoma in 2 cases.Immunohistochemistry showed that HER-2 showed negative in 15 cases,1+in 8 cases,2+in 7 cases and 3+in 4 cases.MUC-2 was positive in 19 cases and negative in 15 cases.FISH detection of HER-2 was performed in 11 cases,and positive signals were found in 6 cases.EBER result showed that 4 cases(12%)were positive and 30 cases were negative.Conclusion There are various histological types of gastric cancer in Tibet,and it mainly occurs in male patients under 60 years old.MUC2 is highly expressed in gastric cancer tissues and intestinal metaplasia glands,especially in mucinous gastric adenocarcinoma,.The proportion of Epstein-Barr virus associated gastric cancer in Tibet is higher than that in the inland.The proportion of patients with HER2 gene amplification in Tibetan patients with gastric cancer is higher than that in the inland.These patients are expected to be benefit from HER-2 targeted therapy.