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目的:探讨食管肉瘤样癌的临床病理特征及预后。方法:通过对20例食管肉瘤样癌进行常规病理、免疫组织化学及电镜超微结构观察,进行临床病理特征及预后分析。结果:食管肉瘤样癌呈息肉样生长,部分发生于溃疡型肿块旁,肿瘤可位于整段食管,但以中段食管最为常见。镜下,肿瘤以肉瘤样成分为主,并可见分化不等的鳞状细胞癌,且两者之间有移行过渡,部分病例仅见肉瘤样成分。肉瘤样成分Vimentin弥漫表达,CK(p)、CK5/6部分表达,α-SMA部分表达,偶尔表达S-100。电镜下,发现有些肉瘤样细胞保留了上皮的标志,可以观察到桥粒连接和张力原纤维,其他多数细胞具有纤维母细胞、肌纤维母细胞或其他间叶细胞的表现,如胶原纤维、中间连接,胞质中可见粗面内质网、高尔基复合体等。1、3年生存率分别为100%、82.4%,预后较好。结论:食管肉瘤样癌是一种少见的、具有特殊临床病理特征的恶性肿瘤。
Objective: To investigate the clinicopathological features and prognosis of esophageal sarcomatoid carcinoma. Methods: Twenty cases of esophageal sarcomatoid carcinoma were studied by routine pathology, immunohistochemistry and electron microscopy. The clinicopathological features and prognosis were analyzed. Results: Esophageal sarcomatoid carcinoma showed polypoid growth partly in the ulcer mass. The tumor could be located in the entire esophagus, but the middle esophagus was most common. Microscopically, sarcomatoid tumor-like components, and visible differentiated squamous cell carcinoma, and transitional transition between the two, in some cases only see sarcomatoid components. The sarcomatoid component Vimentin was diffusely expressed, CK (p), CK5 / 6 partially expressed, α-SMA partly expressed, and S-100 occasionally expressed. Under electron microscopy, some sarcomatoid cells were found to retain the epithelial marker and desmosomes and tension fibrils were observed. The majority of other cells exhibited fibroblasts, myofibroblasts or other mesenchymal cells such as collagen fibers, intermediate connections , The cytoplasm can be seen rough endoplasmic reticulum, Golgi complex. The 1-year and 3-year survival rates were 100% and 82.4% respectively, with a good prognosis. Conclusion: Esophageal sarcomatoid carcinoma is a rare malignant tumor with special clinicopathological features.