鼻腔低级别非肠型腺癌临床病理分析

Low-grade nonintestinal-type adenocarcinoma in the nasal cavity: a clinicopathological analysis

目的探讨鼻腔低级别非肠型腺癌(non-ITACs)的临床特征、生物学行为,以及病理诊断要点。方法分析1例鼻腔低级别non-ITACs患者的临床表现、显微镜下形态及免疫组化特点,追踪随访预后,并复习相关文献。结果患者,女性,20岁。2年来无明显诱因反复鼻出血,时有耳鸣、头痛,嗅觉逐渐丧失。头部增强CT提示右侧后鼻腔内可见一大小2.2 cm×1.2 cm的软组织肿块影。肿瘤完整切除,未行放、化疗,随访4年,未见复发和转移。镜下肿瘤位于固有膜内,边界参差不齐,呈膨胀性浸润,由管状和乳头状腺体组成,腺上皮为单层立方或柱状上皮,核靠近基底部,轻度异型,核分裂象罕见。免疫组化结果显示,CK7、 CEA和S-100均强(+);CK20、SMA、CK5/6、p63、TTF1、CDX-2、CD117、bcl-2、GFAP和villin均(-),Ki-67约5%～10%(+)。结论鼻腔低级别non-ITACs是一种罕见的低度恶性上皮源性肿瘤,呈惰性生物学行为。诊断思路属于排它性诊断,首先排除较常见的涎腺源性肿瘤和肠型腺癌,免疫组化有助于诊断和鉴别诊断,完整切除肿瘤后预后较好。

Objective To investigate the clinical features,biological behavior and the key points of pathological diagnosis of the low-grade nonintestinal-type adenocarcinoma(non-ITACs)in the nasal cavity.Methods The clinical manifestations,imaging features,morphology and immunohistochemical characteristics were analyzed in 1 case of low grade non-ITACs in the nasal cavity.Furthermore,the prognosis was followed up,and the related literatures were reviewed.Results The patient,female,20 years old,presented with a 2-year history of recurrent epistaxis without obvious causes,sometimes tinnitus,headache,and a gradual loss of smell.Head enhanced CT revealed a 2.2 cm×1.2 cm heterogeneous mass in the right posterior nasal cavity.The tumor was completely resected without radiotherapy and chemotherapy,and no recurrence or metastasis was found after 4 years follow-up.Microscopically,the tumor was located in the lamina propria,with uneven boundary and expansive infiltration.It was composed of tubular and papillary glands.The glandular cells were single-layered cubic or columnar epithelia.The nucleus was close to the basement with slightly atypia.The mitotic figure was rare.The immunological results showed that tumor cells were strongly positive for CK7,CEA and S-100,whereas CK20,SMA,CK5/6,p63,TTF1,CDX-2,CD117,Bcl-2,GFAP and villin were all negative,and Ki-67 index was approximately 5%~10%.Conclusion Nasal low-grade non-ITAC is a rare malignant epithelial neoplasm with inert biological behavior.The diagnosis is exclusive,beginning with exclusion of the most common tumors of salivary gland and intestinal type adenocarcinoma.The immunohistochemistry is helpful for diagnosis and differential diagnosis,and the prognosis is better after the complete resection.