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谈东风病例5 Case T0005:胃体 2cm 溃疡, 仅一张白片,该做什么?

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楼主 发表于 2010-05-06 22:54|举报|关注(0)
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姓    名: ××× 性别:  Male 年龄:  47
标本名称:  胃镜活检
简要病史:  Abdominal pain for 4 months. 7 kg weight loss.
肉眼检查:  Endoscopical findings: a round shallow ulcer, 2.0x1.8cm. Surrounding gastric mucosa shows atrophic changes.

 

There are solid neoplastic nests in the mucosa. The tumor cells are cohensive, with scant cytoplasm, and marked intratumor lymphocytes, and background stromal lymphocytes. Morphologically, it is consistent with a poorly differentiated carcinoma, with lymphoepithelial carcinoma features.

 

One helpful marker to test is EBV virus. EBV associated gastric cancer (EBVAGC) was first described in early 1990 by Dr. Lawrence Weisss, who found EBV virus in lymphoepithelial carcinoma of the stomach. More and more literature have been reported, up to 16% of gastric cancer are EBV associated. In one of our recent articles, we have found EBV in other types of gastric cancer including signet ring cell carcinoma and well-differentiated intestinal type adenocarcinoma, though lymphoepithelial carcinoma type shows much higher prevalence (reference:

Characteristics of Epstein-Barr virus-associated gastric cancer: a study of 235 cases at a comprehensive cancer center in U.S.A. J Exp Clin Cancer Res. 2009 Feb 3;28:14.

 

The golden standard to test EBV is in-situ hybridization (ISH), which highlights the EBV virus in the tumor nuclei. The ISH photo of the this case was shown in Figure 6. Other methods to detect EBV include PCR test and ELISA.

 

One of the important messages is that EBV assoicated gastric cancers seem to have a better clinical outcome compared to non-EBV associated gastric cancer.

  • 谈东风病例5 Case T0005:胃体 2cm 溃疡, 仅一张白片,该做什么?图1
    图1
  • 谈东风病例5 Case T0005:胃体 2cm 溃疡, 仅一张白片,该做什么?图2
    图2
  • 谈东风病例5 Case T0005:胃体 2cm 溃疡, 仅一张白片,该做什么?图3
    图3
  • 谈东风病例5 Case T0005:胃体 2cm 溃疡, 仅一张白片,该做什么?图4
    图4
  • 谈东风病例5 Case T0005:胃体 2cm 溃疡, 仅一张白片,该做什么?图5
    图5
  • 谈东风病例5 Case T0005:胃体 2cm 溃疡, 仅一张白片,该做什么?图6
    图6
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本帖最后由 于 2010-05-21 03:48:00 编辑
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×参考诊断
In the following test and one additional photo.

knight 离线

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61 楼    发表于2010-05-11 10:20:00举报|引用
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以下是引用谈东风在2010-5-11 0:22:00的发言:

Hint:

 

 

Sheets of solid, cohensive neoplastic cells in a background of chronic atrophic gastritis (see intestinal metaplasia in the background).

Another important feature: remarkable intratumor lymphocytes!!

翻译:谈老师的提示

在慢性萎缩性胃炎(看背景上的肠化)的背景上见到成片实性的、粘附性的肿瘤细胞

另一个重要特点:明显的肿瘤间的淋巴细胞

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海上明月 离线

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62 楼    发表于2010-05-10 17:08:00举报|引用
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 这是一例癌, 需鉴别NE癌和低分化腺癌。仅一张白片,首选IHC标记CgA。
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王军臣

蓝天白云流水 离线

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63 楼    发表于2010-05-10 16:26:00举报|引用
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 低分化腺癌,ck
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xuleaf 离线

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64 楼    发表于2010-05-07 16:56:00举报|引用
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 低分化腺癌,Syn
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每个人都有潜在的能量,只是很容易:被习惯所掩盖,被时间所迷离,被惰性所消磨.

宁静致远 离线

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65 楼    发表于2010-05-07 15:28:00举报|引用
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  低分化腺癌ck
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66 楼    发表于2010-05-07 13:36:00举报|引用
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 低分化腺癌,可以看看有无伴随神经内分泌分化。
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境随心转

knight 离线

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67 楼    发表于2010-05-06 23:24:00举报|引用
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 弥漫大B细胞淋巴瘤,免疫选择CD20
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