本文回顾性分析了1例胃大细胞神经内分泌癌与腺癌形成的胃碰撞癌伴肝转移患者的临床病理资料,并进行免疫组织化学检测及文献复习,总结了临床病理特征.该例患者肝脏穿刺组织镜下表现为大细胞神经内分泌癌,而胃镜活检组织镜下则表现为大细胞神经内分泌癌和腺癌两种成分,且二者分界明显;胃窦前壁呈现大细胞神经内分泌癌形态,胃小弯呈现高分化管状腺癌形态.免疫组织化学结果示:大细胞神经内分泌癌的神经内分泌肿瘤标志物重组分化簇56(recombinant cluster of differentiation 56,CD56)、突触素(synaptophysin,Syn)均呈阳性,肿瘤蛋白53(protein 53,P53)的蛋白表达异常,错配修复(mismatch repair,MMR)蛋白的表达正常;腺癌的神经内分泌肿瘤标志物均呈阴性,P53的蛋白表达正常,MMR蛋白的表达异常.胃碰撞癌确诊依赖于病理组织形态学及免疫组织化学检查,其病理学特征与胃混合型腺神经内分泌癌极为相似,需进行鉴别诊断.碰撞癌中不同肿瘤成分的侵犯程度及转移范围也存在较大差异,需结合临床相关检测对患者进行个体化治疗.
Gastric collision cancer with abberrant P53 and mismatch repair protein expression accompanied by liver metastasis:A case report and literature review
This study retrospectively analyzes the clinical and pathological data of a patient with gastric collision cancer comprising large cell neuroendocrine carcinoma(LCNEC)and adenocarcinoma,accompanied by liver metastasis.Immunohistochemical analysis and a literature review were conducted to summarize the clinicopathological features.Liver biopsy revealed LCNEC,while gastric biopsy demonstrated two distinct components-LCNEC and adenocarcinoma-with a clear boundary.Morphologically,the anterior wall of the gastric antrum showed LCNEC,while the lesser curvature presented highly differentiated tubular adenocarcinoma.Immunohistochemically,the neuroendocrine markers recombinant cluster of differentiation 56(CD56)and synaptophysin(Syn)were positive in LCNEC,while protein 53(P53)expression was aberrant,and mismatch repair(MMR)protein expression was normal.In contrast,the adenocarcinoma component was negative for neuroendocrine tumor markers,exhibited normal P53 expression,but showed abnormal MMR protein expression.The diagnosis of gastric collision cancer relies on histopathological and immunohistochemical examination,and its pathological features are highly similar to those of gastric mixed adenoneuroendocrine carcinoma,necessitating differential diagnosis.The invasion depth and metastatic extent of the different tumor components in collision cancer can vary significantly,requiring individualized treatment based on clinical findings and relevant tests.
gastric collision cancerlarge cell neuroendocrine carcinomaadenocarcinomaprotein 53liver metastasismismatch repair protein
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