胃粘膜为什么会得印戒细胞癌癌病因有哪些?

来源：蜘蛛抓取(WebSpider) 时间：2017-01-04 17:48 标签： 印戒细胞癌早期症状
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胃黏膜内印戒细胞癌19例病理及免疫表型分析
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.
Abstract：
Objective To investigate the histological features and associated gene protein expression of gastric signet-ring cell carcinoma. Methods Gastroscopic biopsy specimens were used to analyse the histological changes,and the diagnosis was then confirmed by pathologic examination of surgically removed tumors in 19 cases. The immunohistochemical SP method was used to detect the expression of HER-2, p53, PTEN, CD44, E-cadherin and other 27 related gene proteins. Results Intramucosal signet-ring cell carcinoma with superficial ulceration was the most common type, followed by flat type, mild depression and mild elevated types. Cytologic characteristics showed six patterns: ① deviation nucleus, forming the classic signet ring cell morphology and the dilated cytoplasm due to spherical expansion. There existed one of two types: mucus in the cytoplasm and non-mucinous cytoplasm,or tr② centrally located nucleus, similar to histiocytes: there were a small number of o③ strong eosinophilic cytoplasm, and cytoplasm containing④ small cell size with nuclear deviation or central nucleus: there was a small amount ⑤ mucus containing no nuclei,and only the outl⑥ degenerative cells with deviated nucleus and deeply stained cytoplasm with or without mucus. Histological structures showed glandular cavity or cell nest like vacuoles, or lacy, thin trabecular structure, or a scattered single ring-like cells. There was less interstitial collagen fibers,accompanied by extracellular mucus secretion. Immunophenotyping demonstrated that the expression of different molecular weight keratin, tumor-associated carbohydrate antigen and nuclear mucin Muc-1, which had a negative correlation with nuclear mucin Muc-2 and Muc-5AC expression. There were over expression of tumor suppressor gene p53, metastasis-promoted gene CD44,and metastasis suppressor gene nm23. Conclusion Gastric signet-ring cell carcinoma is characterized by young age at onset, highly aggressive and higher rate of early lhistopathological diagnosis should be combined with the immunophenotype of the cancer in order to improve the rate of early diagnosis and also to evaluate the prognosis.
WANG Yang-kun
GAO Chun-fang
ZHANG Xian-wei
作者单位：
解放军第150中心医院,病理科,济南军区医学病理中心,河南,洛阳,471031
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