消化道转移癌25例临床病理特征分析

Analysis on the clinicopathological features of 25 cases of metastatic carcinoma in the digestive tract

目的探讨消化道转移癌的临床病理特征,为恶性肿瘤患者消化道转移早发现和诊断提供经验。方法回顾性收集郑州大学第一附属医院2011年1月至2021年12月病理诊断为消化道转移癌的25例患者的临床病理资料,进行归纳性描述和分析。结果25例消化道转移癌中肺癌11例,乳腺癌8例,肾细胞癌4例,尿路上皮癌2例。男14例,女11例;年龄28~73岁,平均55.6岁,确诊消化道转移癌时平均57.9岁。原发癌与消化道转移癌确诊时间间隔平均36个月。上消化道转移癌9例,下消化道转移癌16例。当确诊消化道转移癌时,15例患者存在其他脏器的转移灶,其余10例患者均存在全身多处淋巴结转移。镜下可见黏膜表面多完整,癌组织与周围黏膜过渡陡然,易见脉管癌栓;转移性肺腺癌多呈实性片状生长,乳腺癌多表现为低分化、条索状浸润生长。转移癌能较好地特异性表达相关免疫组化标志。结论癌发生消化道转移往往是其进展的晚期事件。当遇到形态学较为特殊的消化道恶性上皮性肿瘤时,应考虑转移癌的可能,关注患者病史,并合理选用免疫组化检测,以避免漏诊和误诊。

Objective To explore the clinicopathological features of metastatic carcinoma in the digestive tract,and to provide experience for early detection and diagnosis of metastatic carcinoma in the digestive tract in patients with malignant tumors.Methods The clinicopathological data of 25 patients with pathological diagnosis of metastatic carcinoma in the digestive tract in the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2021 were retrospectively collected for inductive description and analysis.Results Among the 25 cases with metastatic carcinoma in the digestive tract,there were 11 cases of lung cancer,8 cases of breast cancer,4 cases of kidney cancer and 2 cases of urothelial cancer.Among the 25 cases with metastatic carcinoma in the digestive tract,14 cases were male and 11 cases were female.The patients ranged in age from 28 to 73 years,with a mean age of 55.6 years.The mean age of the patients was 57.9 years at the time when metastatic carcinoma in the digestive tract was definitely diagnosed.The average interval between the time of diagnosis of primary carcinoma and the time of diagnosis of metastatic carcinoma in the digestive tract was 36 months.Among the 25 cases with metastatic carcinoma in the digestive tract,9 cases had metastatic carcinoma in the upper digestive tract and 16 cases had metastatic carcinoma in the lower digestive tract.At the time of definite diagnosis of metastatic carcinoma in the digestive tract,15 cases had metastases in other organs,and the other 10 cases had lymph node metastases in multiple sites in the whole body.Under the microscope,the mucosal surface was mostly intact,and the transition between tumor tissues and their surrounding mucosa was abrupt,and vascular cancer thrombi were easily seen.Metastatic lung adenocarcinoma was mostly solid and flaky growth,while breast cancer was mostly poorly differentiated and cord-like infiltrating growth.Metastatic carcinoma could express relevant immunohistochemical markers with good specificity.Conclusion The occurrence of metastatic carcinoma in the digestive tract often indicates a late stage event in its progression.When malignant epithelial tumors of the digestive tract with unique morphology are observed,the possibility of metastatic carcinoma should be considered.The patients′medical history is paid attention to and immunohistochemical detection is reasonably chosen to avoid missed diagnosis and misdiagnosis.