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目的观察食管基底细胞样鳞状细胞癌(basaloid-squamous carcinoma,BSC)的组织学形态特征,探讨其诊断及鉴别诊断。方法对15例BSC标本进行光镜、电镜及免疫组织化学研究。结果BSC组织学有许多与涎腺腺样囊性癌(adenoid cystic carcinoma,ACC)相似的特征。但BSC癌细胞分化较低异型性较强,癌巢周围细胞呈栅栏状排列,肿瘤表面鳞状上皮常伴发原位癌或浅表浸润性鳞状细胞癌;偶见癌巢与表面鳞状上皮基底层相连、或偶见癌巢内形成鳞状细胞,或腺管样结构,这些与ACC不同。超微结构与ACC相似,但癌细胞分化更低,胞质内可见张力原纤维是与ACC不同之处。免疫组化结果:基底细胞样成分:CK(pan)15/15、EMA15/15、CEA6/15、S-100 6/15、SMA7/15阳性,显示肿瘤含有上皮和肌上皮细胞。结论BSC是一种分化较低、侵袭性较强,有向腺样、鳞状及肌上皮细胞分化倾向,具有独特临床病理特征的恶性肿瘤,其组织学特征可作为病理诊断标准,超微结构及免疫组织化学特征可辅助鉴别诊断。
Objective To observe the histopathological features of basaloid-squamous carcinoma (BSC) and to explore its diagnosis and differential diagnosis. Methods Light microscopy, electron microscopy and immunohistochemistry were performed on 15 BSC specimens. Results There are many features of BSC histology that are similar to those of adenoid cystic carcinoma (ACC). However, BSC cancer cells were less differentiated and highly isoplastic, and the cells around the cancer nests were arranged in a palisade-like manner. Squamous epithelium on the surface of the tumor was often accompanied by carcinoma in situ or superficial infiltrating squamous cell carcinoma; occasional cancer nests and superficial squamas were observed. Epithelial basal layers are connected, or occasionally squamous cells, or duct-like structures are formed in cancer nests, which are different from ACC. The ultrastructure is similar to that of ACC, but the differentiation of cancer cells is even lower. Tension fibrils are seen in cytoplasm which are different from ACC. Immunohistochemical results: basal cell-like components: CK (pan) 15/15, EMA15/15, CEA6/15, S-100 6/15, SMA7/15 positive, showing that the tumor contains epithelial and myoepithelial cells. Conclusion BSC is a kind of malignant tumor with low differentiation, strong invasiveness, and tendency to differentiate into adenoid, squamous and myoepithelial cells. It has unique clinicopathological features. Its histological features can be used as pathological diagnostic criteria, ultrastructure. And immunohistochemical features can assist in differential diagnosis.