CAJ | 학술논문

目的探讨阑尾杯状细胞类癌(GCC)的临床病理特征、诊断标准及治疗预后.方法分析郑州大学附属洛阳市中心医院6例GCC患者的临床病理资料.结果 6例患者平均发病年龄为48.67岁,临床上4例表现为急性阑尾炎的症状和体征,2例表现为腹部疼痛;手术方式:4例为阑尾单纯切除术,2例为阑尾切除术+右半结肠切除术;术后平均随访30个月,5例健康生存,1例失访.大体观察阑尾无明显肿块.显微镜下观察:4例肿瘤细胞似肠腺杯状细胞,无异型性和坏死,缺乏核分裂象,2例肿瘤细胞呈圆形及多边形,中等大小,胞质丰富,富含黏液,细胞核偏于一侧,呈印戒细胞样,瘤细胞呈巢状、花环状、腺样弥漫散在排列.免疫组织化学示:Syn阳性6例,CgA阳性4例,NSE、CD56、CK7、CK20均有患者阳性,5例Ki-67≤2％,1例Ki-67为3％,6例均未发现淋巴结、肠道、卵巢转移.结论 GCC是一种少见的神经内分泌肿瘤,较经典类癌更具有侵袭性.Syn、CgA阳性为诊断所必需的,Ki-67阳性指数对肿瘤分级有指导意义.
목적 탐토란미배상세포유암(GCC)적림상병리특정、진단표준급치료예후.방법 분석정주대학부속락양시중심의원6례GCC환자적림상병리자료.결과 6례환자평균발병년령위48.67세,림상상4례표현위급성란미염적증상화체정,2례표현위복부동통;수술방식:4례위란미단순절제술,2례위란미절제술+우반결장절제술;술후평균수방30개월,5례건강생존,1례실방.대체관찰란미무명현종괴.현미경하관찰:4례종류세포사장선배상세포,무이형성화배사,결핍핵분렬상,2례종류세포정원형급다변형,중등대소,포질봉부,부함점액,세포핵편우일측,정인계세포양,류세포정소상、화배상、선양미만산재배렬.면역조직화학시:Syn양성6례,CgA양성4례,NSE、CD56、CK7、CK20균유환자양성,5례Ki-67≤2％,1례Ki-67위3％,6례균미발현림파결、장도、란소전이.결론 GCC시일충소견적신경내분비종류,교경전유암경구유침습성.Syn、CgA양성위진단소필수적,Ki-67양성지수대종류분급유지도의의.
Objective To explore the clinicopathologic features,diagnostic criteria and clinical prognostic factors of Goblet cell carcinoid (GCC) of the appendix.Methods The clinical and pathological data from 6 GCC patients were analyzed including age,clinical stage,surgical procedure,outcome,macroscopic features,histological sections and immunohistochemistry.Results The median age was 49.67 years old.Clinically,4 patients presented the signs and symptoms of acute appendicitis,while 2 patients presented the signs and symptoms of abdominal pain.4 patients of them undergone the simple appendectomy,the other 2 undergone the right hemicolectomy.All patients who had undergone the operation treatment survived.One patient was lost to the follow-up.Macroscopically,no masses were found in the appendix.Microscopically,4 cases showed that the tumor cells were identical to the goblet cell normal small intestinal crypts morphologically.The atypia,necrosis and mitotic figures of neoplasm cells were absent.2 cases were composed of small,discrete acini,tubules lined by a single layer of cuboidal or columnar cell,the signet-ring cells were uniform with pattern of infiltration being nests,rosrttes,or clumps without a dintinct lumen.All GCC cases were positive to Syn,4 cases were positive to CgA,some cases expressed NSE,CD56,CK7,CK20,Ki-67 index of 5 cases was under 2 ％,the other 1 was 3 ％.None had lymph node metastases,intestinal metastases or ovary metastases.Conclusions GCC of appendix is a rare neoplasm,and has more aggressive behaviour than classic carcinoids.Positive expression of Syn and CgA is necessory for the diagnosis of GCC,Ki-67 index may suggest the grading of tumor.