原发性直肠杯状细胞腺癌的临床病理研究

Clinicopathological features of primary rectal goblet cell adenocarcinoma

目的分析原发性直肠GCA的临床病理特征。方法收集原发性直肠GCA癌患者的临床资料,通过H&E染色、免疫组织化学染色、特殊染色、透射电镜及二代测序等方法分析直肠GCA的临床病理特征。结果肿瘤主要由短柱状/印戒样细胞、潘氏样细胞及神经内分泌样细胞组成,肿瘤细胞呈单个、管-筛状、簇状或菊形团样分布,伴神经及脉管侵犯。免疫组化结果:肿瘤细胞表达CKpan、CK20、CDX2、SSTR2及Syn;D⁃AB/PAS染色显示黏液阳性。透射电镜显示肿瘤细胞内存在黏液小泡及神经内分泌颗粒。二代测序显示ERBB2及P53错义突变。结论直肠GCA较罕见,本研究深入到电镜和分子层面分析该肿瘤的临床病理特征,为临床精准治疗提供依据。

Objective To investigate theclinicopathological features ofthe primary rectal goblet cell adenocarcinoma(GCA).Methods Clinicopathological data of primary rectal GCA were collected and analyzed by H&E staining,immunohistochemistry,special staining,transmission electron microscopy and next generation sequencing(NGS).Results GCA was composed of goblet⁃like cells with rich mucus in the cytoplasm,neuroendocrine cells,and Paneth⁃like cells.The tumor cells arranged as nest⁃like distribution.Immunohistochemical staining results showed tumor cells were positive for CK,CK20,CDX2,SSTR2,Syn.D⁃AB/PAS staining result showed there was some mucus in tumor cells.TEM result showed the neuroendocrine granules and mucous vesicles were observed in the same goblet⁃like cell of the tumor tissue.NGS results showed ERBB2 and P53 missense mutations in the tumor.Conclusion Rectal GCA is relatively rare.This study has in-depth analysis of clinical and pathological features of primary rectal GCA at electron microscopic and molecular levels,which provides basis for clinical accurate treatment.