食管基底样鳞状细胞癌17例临床病理分析

Basaloid-Squamous Cell Carcinoma of the Oesophagus:A Clinicopathologic Study of Seventeen Cases

目的:观察食管基底样鳞状细胞癌的临床病理特点,为病理诊断和鉴别诊断提供依据。方法:采用组织病理学、组织化学及免疫组化SP法染色,对17例食管基底样鳞状细胞癌患者系统分析。结果:基底样鳞状细胞癌由密集的小细胞组成,该细胞类似于鳞状上皮的基底层细胞,其组织结构呈巢状、伴中央坏死的大分叶状、筛网状、一致小圆状未分化细胞构成的缎带状,9例合并中、高分化鳞状细胞癌,l例合并腺癌,2例粘膜重度不典型增生伴癌变,1例食管合并另两处独立鳞癌;瘤细胞CgA、Syn、S-100、Actin、CEA均阴性,AE1、AE3、CK34βE12局灶阳性,Ki-67阳性率为50%～80%,癌巢内基底样癌细胞间见丰富的Ⅳ型胶原。结论:基底样鳞状细胞癌是食管少见的鳞状细胞癌变异型,是具有独特形态特点、明显侵袭性的生物学行为和预后差的肿瘤,应与其他恶性肿瘤鉴别。

Objective: To observe the clinicopathologic features of the basaloid-squamous carcinoma(BSC) in the oesophagus and provide warrants for diagnosing and differentiating it from other tumors. Methods: Used HE, AB and PAS and SP immunohistochemiscal stains to study 17 cases of our own department, followed up all patients. Results: BSCs were composed of small cells similar to the basal cells of squamous epithelium, which consisted of four tissue patterns (solid nests, large lobules with comedonecrosis, cribriform pattern, ribbon-like arrangement of monotonous small round undifferentiated cells). There were varied proportions of four patterns in our 17 cases, 9 of which companied with well differentiated squanmous cell carcinoma(SCC), 1 case with adenocarcinoma, 2 cases with high atypical hyperplasitic epithelium, 1 case with two independent SCC. The tumor cells were negative for CgA, Syn, S-100, Actin, CEA, part cells reacted with AE1, AE3, CK34βE12, and cells positive for Ki67 ranged from 50% to 80%. Immunoreactivity for type IV collagen was observed among the basloid carcinoma cells inside the carcinomatous nest. Conclusion: BSC is a very rare but distinct subtype of squamous cell carcinoma. Since it has a charateristic histopathology, expression of immunoreactivity, obviously invasive behavior and poor prognosis,it should be distinguished from other malignant tumors.