目的 探讨活检标本中伴肠母细胞分化胃腺癌(gastric adenocarcinoma with enteroblastic differentiation,GAED)的诊断和临床病理特征,为胃早癌内镜切除标本病理评估提供资料.方法 收集26例GAED活检标本,复读切片、行免疫组化染色,联合根治术标本分析临床病理特征.结果 其中16例患者术前检测了血清AFP水平,11例升高(68.75％).GAED活检初诊率42.31％、复诊率92.31％.5例活检GAED伴有普通型腺癌,SALL4和Glypican-3阳性率较高(均为78.57％);根治术标本伴发癌包括普通型腺癌、肝样腺癌和低黏附性腺癌,SALL4阳性率较高(81.25％),Glypican-3居中(75％),AFP较低(62.5％).GAED比普通型腺癌更易出现胃壁深层侵犯和淋巴结转移,6例早期GAED中3例淋巴结阳性(50％).结论 GAED在活检标本中易漏诊,应加强对其组织学特征和免疫表型的重视,建议将GAED纳入胃早癌内镜下非治愈性切除的组织学类型.
Pathological diagnosis of gastric adenocarcinoma with enteroblastic differentiation in endoscopic biopsies
Purpose To investigate the diagnosis and the clinicopathological characteristics of gastric adenocarcinoma with enteroblastic differentiation(GAED)in biopsy,and to provide data for the pathological evaluation of endoscopic resection of early gastric cancer.Methods 26 GAED biopsy specimens were collected,and the clinicopathological features were ana-lyzed by re-reading slides,immunohistochemistry and with paired radical surgery specimen.Results Serum AFP was de-tected in 16 patients before operation,and 11 patients(68.75％)were elevated.The initial diagnosis rate and follow-up rate of GAED in biopsy were 42.31％and 92.31％.Among the biopsy specimens,5 cases of GAED were accompanied by conventional gastric adenocarcinoma,and the positive rates of SALL4 and Glypican-3 were high(both 78.57％).The accom-panying cancers in the radical resection specimens include con-ventional gastric adenocarcinoma,hepatoid adenocarcinoma,and low adhesion adenocarcinoma,with the positive rate of SALL4(81.25％),Glypican-3(75％),and AFP(62.5％).GAED was more prone to deep invasion of the gastric wall and lymph node metastasis than conventional gastric adenocarcinoma.A-mong the 6 cases of early GAED,3 cases(50％)were lymph node-positive.Conclusion GAED is easy to be missed in biop-sy,and more attention should be paid to its tissue morphology and immunophenotype.GAED needs to be excluded in the histo-logical type of endoscopic curative resection of early gastric canc-er.
gastric adenocarcinoma with enteroblastic differenti-ationearly gastric cancerendoscopic biopsypathological e-valuation
万方数据
维普
