EB病毒阴性胃淋巴上皮瘤样癌1例并文献复习

Epstein-Barr virus-negative lymphoepithelioma-like gastric carcinoma:A case report and literature review

回顾性分析1例胃淋巴上皮瘤样癌(lymphoepithelioma-like gastric carcinoma,LELGC)患者的临床病理特点并复习相关文献。本例患者因剑突下疼痛入院,外院胃镜提示胃窦部巨大溃疡,入院增强CT提示胃窦部胃壁增厚并明显强化,考虑胃窦部恶性肿瘤,行根治性手术切除。术后病理检查提示:远端胃可见一大小约为4.5 cm×5.5 cm×1.0 cm的溃疡型肿物,似侵及深肌层。特殊染色结果示幽门螺杆菌阳性。原位杂交结果示Epstein-Barr病毒(Epstein-Barr virus,EBV)编码区阴性。免疫组织化学染色示广谱细胞角蛋白、表皮生长因子受体、P53(野生型)、上皮膜抗原、细胞黏附分子、黏蛋白(mucin,MUC)-6均为阳性,细胞增殖的相关抗原Ki-67为60%阳性,淋巴细胞共同抗原和CD3均为部分阳性,人髓细胞增生原癌基因、细胞周期蛋白D1和CD5均为弱阳性,人类表皮生长因子受体-2、D20、CD10、多发性骨髓瘤癌基因1、CD79a、B细胞白血病/淋巴瘤(B-cell leukemia/lymphoma,BCL)-2、BCL-6、CD56、间变性淋巴瘤激酶、配对盒蛋白5、突触素、嗜铬粒蛋白A、CD8、波形蛋白、黑色素瘤相关抗原HMB45、黑色素A、神经特异性蛋白质S-100、SOX10、E-钙黏蛋白、尾侧型同源盒转录因子-2、MUC-5ac、MUC-2均为阴性。苏木精-伊红染色结果示:肿瘤细胞核分裂活跃,可见病理性核分裂象。通过文献复习发现,80%以上的LELGC患者与EBV感染相关,早期LELGC主要通过内镜黏膜下剥离或根治性切除术治疗,而晚期患者多采用姑息性治疗。LELGC患者过度表达程序性死亡受体配体1,这表明程序性死亡受体1/程序性死亡受体配体1抑制剂可作为LELGC的潜在治疗靶点,具有广阔的治疗前景。

To retrospectively analyze the clinicopathological features of a patient with lymphoepithelioma-like gastric carcinoma(LELGC)and review the related pieces of literature.The patient was admitted to the hospital due to subxiphoid pain,and an initial gastroscopy at an external hospital revealed a huge ulcer in the gastric antrum.Contrast-enhanced CT on admission showed that the gastric wall in the gastric antrum was thickened and significantly enhanced,raising suspicion of malignancy.Consequently,a radical resection was performed.Postoperative pathology showed an ulcerative mass of 4.5 cm×5.5 cm×1.0 cm in the distal stomach,which seemed to invade the deep muscle layer.Special staining results showed that Helicobacter pylori was positive.Situ hybridization results showed that Epstein-Barr virus(EBV)encoding region was negative.Immunohistochemical staining results showed that cytokeratin-Pan,epidermal growth factor receptor,P53(wild type),epithelial membrane antigen,cell adhesion molecule,and mucin(MUC)-6 were all positive;and antigen associated cell proliferation(Ki-67)was 60%positive.Lymphocyte common antigen and CD3 were partially positive;while human cellular myelocytomatosis oncogene,cyclin D1,and CD5 were weakly positive;whereas human epidermal growth factor receptor-2,D20,CD10,multiple myeloma oncogene 1,CD79a,B-cell leukemia/lymphoma(BCL)-2,BCL-6,CD56,anaplastic lymphoma kinase,paired box protein 5,synapsin,chromograin protein A,CD8,Vimentin,melanoma associated antigens HMB45,melanin A,neural specific protein S-100,sex determining region Y-box 10,E-cadherin,caudaltype homeobox transcription factor-2,MUC-5ac,MUC-2 were all negative.Hematoxylin and eosin staining results showed active tumour cell nuclear division with pathological mitotic figures.Through literature review,it is found that more than 80%of LELGC cases are associated with EBV infection.Early-stage LELGC is primarily treated with endoscopic submucosal dissection or radical resection,while advanced-stage patients mostly receive palliative treatment.LELGC patients over-express programmed death ligand 1,which indicates that programmed death receptor 1/programmed death receptor ligand 1 inhibitors can be used as potential therapeutic targets for LELGC and have broad therapeutic prospects.