伴导管分化的食管癌临床病理学特征观察

Clinicopathological features of esophageal carcinoma with ductal differentiation of esophageal gland

目的探讨伴导管分化的食管癌的临床病理学特征。方法对苏州大学附属第一医院2012—2022年诊断的8例伴导管分化的食管癌的临床特征、形态学特点、免疫组织化学特点以及随访信息总结分析。结果8例中男女各4例;平均年龄68.5岁(59~82岁);2例位于食管中段,5例位于下段,1例位于贲门处(SiewertⅡ型)。平均直径2.4 cm(0.6~4.5 cm)。肿瘤镜下呈腺样形态,具有双层上皮结构,包含内层腔面上皮与外层基底上皮。内层腔面上皮免疫组织化学细胞角蛋白(CK)7、CK18均阳性。外层基底上皮p40、p63与CK5/6均阳性,平滑肌肌动蛋白、Calponin、CD117均阴性。双层上皮均可见p53呈突变型(弥漫强阳性6/8;缺失表达2/8)。所有病例表面鳞状上皮均未见柱状上皮化生、肠上皮化生以及胃黏膜异位。平均随访时间21.5个月(5~51个月),其中7例存活,1例术后31个月因肿瘤复发及肝转移去世。结论伴导管分化的食管癌是一种少见的食管肿瘤,具有独特的组织形态和免疫组织化学特点。

Objective To investigate the clinicopathological characteristics of esophageal carcinoma with gland duct differentiation.Methods The clinical,morphologic and immunohistochemical(IHC)features of eight cases of esophageal carcinoma with gland duct differentiation diagnosed from 2012 to 2022 at the First Affiliated Hospital of Soochow University were summarized.Results There were four males and four females,with a mean age of 68.5(range 59-82)years.Two tumors were located in middle esophagus,five in the lower esophagus,and one in the cardia.The mean diameter was 2.4 cm(range 0.6-4.5 cm).The tumor had a bilayer epithelial structure,including the inner luminal epithelium and the outer basal epithelium.Immunohistochemistry showed that CK7(8/8)and CK18(8/8)were positive in the inner epithelium.p40(8/8),p63(8/8)and CK5/6(8/8)were positive in the outer epithelium.SMA,calponin and CD117 were all negative.p53 mutants were found in all eight cases(strong and diffuse positivity in 6/8;complete loss of expression in 2/8).No columnar metaplasia,intestinal metaplasia and ectopic gastric mucosa were observed in the surface squamous epithelium in the cases.The mean follow-up time was 21.5 months(range 5-51 months).Seven patients survived and one patient died 31 months after surgery due to recurrence and liver metastasis.Conclusion Esophageal carcinoma with esophageal gland duct differentiation is a rare tumor with unique histologic and IHC characteristics.