论文部分内容阅读
目的探讨胃黏膜内印戒细胞癌的病理组织学特点及免疫表型的临床意义。方法先对胃镜活检标本进行组织学观察,再经手术切除证实为胃黏膜内印戒细胞癌共19例,全部采用免疫组化SP法检测HER-2、p53、PTEN、CD44、E-cadherin等27种相关基因蛋白。结果黏膜内印戒细胞癌以浅表溃疡型最常见,其次为平坦、轻度凹陷和轻度隆起型。细胞学有6种形态:①核偏位,形成经典的印戒细胞形态,细胞质因扩张而呈球形。以细胞质内有/无黏液又分2型。②细胞核位于细胞中央,类似于组织细胞,少量/无核分裂象。③胞质强嗜酸性,且胞质内含微小黏液颗粒。④细胞体积小,核偏位或中位,有少量/无黏液。⑤无细胞核仅有含黏液的胞质轮廓。⑥退形性变的细胞,胞核多偏位且深染,胞质无/有黏液。组织学表现为腺体、腺腔结构的空泡样细胞巢,或花边状、纤细的梁状结构,或单个印戒样癌细胞散在分布。间质有较少的胶原纤维,可伴有细胞外黏液分泌。免疫表型:不同分子质量角蛋白、肿瘤相关的糖类抗原和核黏蛋白Muc-1(),而与核黏蛋白Muc-2、Muc-5AC的阳性表达呈负相关。抑癌基因p53蛋白、转移促进基因CD44蛋白、转移抑制基因nm23蛋白均有较高表达。结论胃黏膜内印戒细胞癌发病年龄轻、侵袭性强、淋巴结早期转移率高;组织病理学诊断要结合免疫表型分析,以提高早期诊断率,同时亦是评价预后的重要参考指标。
Objective To investigate the histopathological features and immunophenotype of signet ring cell carcinoma in gastric mucosa. Methods Twenty-nine cases of signet-ring cell carcinoma of gastric mucosa were confirmed by histological observation of gastroscopic biopsy specimens and all of them were immunohistochemically stained for HER-2, p53, PTEN, CD44 and E-cadherin 27 kinds of related gene protein. Results The mucosal signet ring cell carcinoma with superficial ulceration was the most common, followed by flat, mild depression and mild bulge. Cytology has six kinds of morphology: ① nuclear deviation, the formation of a classic signet ring cell morphology, the cytoplasm due to the expansion and spherical. With cytoplasm / mucus is divided into 2 types. ② nucleus located in the center of the cell, similar to the tissue cells, small / no mitotic figure. ③ strong eosinophilic cytoplasm, and cytoplasm containing small mucus particles. ④ small cell size, nuclear deviation or median, a small amount / no mucus. ⑤ cell-free only with mucus cytoplasm contour. ⑥ degenerative changes in the cells, the nucleus multi-deviation and deep-stained, cytoplasmic / mucus. Histological findings were vacuole-like cell nests of glandular and glandular structures, or scattered lace-like, slender beam-like structures or single signet-ring-like cancer cells. Interstitial collagen fibers less, may be associated with extracellular mucus secretion. Immunophenotype: different molecular mass keratin, tumor associated carbohydrate antigen and nuclear mucin Muc-1 (), but with nuclear mucin Muc-2, Muc-5AC positive expression was negatively correlated. Tumor suppressor gene p53 protein, metastasis promoting gene CD44 protein and metastasis suppressor gene nm23 protein all have higher expression. Conclusion The diagnosis of signet-ring cell carcinoma in gastric mucosa is young, invasive and early lymph node metastasis. Histopathologic diagnosis should be combined with immunophenotyping to improve the early diagnosis rate, and it is also an important reference index for evaluating prognosis.