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目的探讨伴有横纹肌样特征的低分化胃腺癌的临床病理特征、诊断与鉴别诊断,以提高对本肿瘤的认识。方法应用光镜和免疫组化染色对1例罕见的伴有横纹肌样特征的低分化胃腺癌进行观察,并复习相关文献。结果镜下伴有横纹肌样特征的肿瘤细胞弥漫片状或腺泡状排列,侵犯胃壁全层。肿瘤细胞黏附性差,呈类圆形或不规则形,胞质丰富,强嗜酸性,可见红染均质包涵体,核泡状、偏位,核仁突出,核分裂象易见。免疫组化肿瘤细胞vimentin弥漫(+),CAM5.2部分(+),Muc-5AC灶状(+),Ki-67增殖指数80%。结论伴有横纹肌样特征的低分化胃腺癌是极为罕见的高度恶性肿瘤,特征性的组织学形态及免疫组化标记有助于诊断与鉴别诊断。
Objective To investigate the clinical and pathological features, diagnosis and differential diagnosis of poorly differentiated gastric adenocarcinoma with rhabdomyosarcomatous features in order to improve the understanding of this tumor. Methods A case of poorly differentiated gastric adenocarcinoma with rhabdomyosarcoma was observed by light microscopy and immunohistochemical staining, and the related literatures were reviewed. Results Microscopy with rhabdomyosarcoma characterized by diffuse lamellar or alveolar tumor cells, violation of the full-thickness gastric wall. Tumor cell adhesion is poor, was round or irregular shape, rich in cytoplasm, eosinophilic, visible red dye homogenous inclusions, nuclear bubble, deviation, prominent nucleoli, mitotic easy to see. Immunohistochemical staining of vimentin diffuse (+), CAM5.2 (+), Muc-5AC (+) and Ki-67 proliferative index 80%. Conclusions Poorly differentiated gastric adenocarcinoma with rhabdomyosarcoma is a very rare and highly malignant tumor. The characteristic histological features and immunohistochemical markers contribute to the diagnosis and differential diagnosis.