【摘要】 目的:伴有肠母细胞分化的胃癌(gastric cancer with enteroblastic differentiation,GCED)是一种新的胃癌类型。该肿瘤表达胚胎干细胞标志物为SALL4以及癌胚蛋白(AFP和GPC3)等。本研究旨在探讨GCED的临床病理学特征及其分子表型。方法:回顾性分析2013年3月至2017年3月浙江大学医学院附属第一医院就诊的胃部肠型腺癌337例,其中8例可诊断为GCED,患者均为老年人,其中男性6例,女性2例,年龄68～83岁,平均年龄为76.6岁。2例治疗前血清AFP≥200μg/L。收集相关临床资料,根据其组织病理学形态,采用免疫组织化学法分析免疫学表型,应用逆转录PCR(RT-PCR)方法检测SALL4基因。结果:显微镜下观察,所有病例均具有原始的肠样结构,由立方或柱状细胞组成,胞质透明、清晰,免疫组织化学法检测显示AFP和GPC3阳性,或SALL4阳性。RT-PCR检测结果显示SALL4基因mRNA的表达水平显著增高。随访1～5年,其中5例出现肝及其他脏器转移,2例死亡,1例无瘤生存。结论:GCED是一种罕见的侵袭性肠型腺癌,预后比普通肠型腺癌差,按照普通肠型腺癌的治疗方法效果甚微。其组织学上具有特征性的改变,熟悉其瘤谱及基因学特征有助于鉴别和诊断,有助于对原始标记物,制定如SALL4的靶向治疗方案。更多还原

【Abstract】 Objective: To investigate the clinicopathological features and molecular phenotypes of gastric cancer with enteroblastic differentiation(GCED). Methods: A retrospective analysis of 337 patients with gastric adenocarcinoma diagnosed by the pathology department of the First Affiliated Hospital of Zhejiang University in March 2013-2017 was conducted. Of them, 8 patients were diagnosed with gastric carcinoma with intestinal blastocyte differentiation. All the patients were elderly, including 6 men and 2 women.The onset age was 68-83 years(mean 76.6 years). Two cases had serum AFP ≥200 μg/L before treatment. According to the histopathological morphology, the immunophenotype was analyzed by immunohistochemistry, the SALL4 gene was detected using reverse transcription-polymerase chain reaction(RT-PCR), and the relevant literature was reviewed. Results: Microscopically, all cases had primitive enteroid structures, consisting of cubic or columnar cells with clear cytoplasm, and immunohistochemical staining showed positivity for either AFP and GPC3 or SALL4. The expression of SALL4 m RNA was significantly increased by RT-PCR. Follow-up from 1 to 5 years showed that 5 patients had liver and other organ metastases, 2 patients died, and 1 patient survived without a tumor. Conclusions:GCED is a rare invasive gastric adenocarcinoma with a worse prognosis than that of normal intestinal adenocarcinoma. The treatment of general intestinal adenocarcinoma has little effect. There are some characteristic changes in histology. It would be helpful for diagnosis and differential diagnosis if clinicians are familiar with the tumor spectrum and genetic characteristics. Target therapy for an original marker, such as SALL4, has a bright future.更多还原