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- 食管贲门交界处病变
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Basaloid squamous cell carcinoma of the head and neck: role of HPV and implication in treatment and prognosis J Clin Pathol 2010;63:857-866 doi:10.1136/jcp.2010.078154
Abstract
Basaloid squamous cell carcinoma (BSCC) is a rare variant of squamous cell carcinoma (SCC) of the head and neck. Wain's criteria (peripheral palisading, association with SCC, high nuclear-cytoplasmic ratio, high mitotic rate, solid growth), anti-34BE12 and CK 5/6 staining, and absence of neuroendocrine markers are mandatory for the diagnosis of BSCC. Its increasing incidence parallels that of human papilloma virus (HPV)-positive tumours for the oropharyngeal subsite. On the other hand, BSCC is frequently considered a high-grade carcinoma of poorer prognosis than its SCC counterparts, mostly due to a higher rate of distant metastases. However, BSCC has similar or better locoregional control rates and a relatively better radiosensitivity than SCC. BSCC seems to have a dual behaviour depending, at least partly, on its recently described association with HPV. The basaloid subtype of SCC, owing to its particular behaviour, should be systematically investigated along with HPV and smoking status, as those factors may be determinant in the response to treatment.
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以下文献是一篇对本例具有启示的资料。文中提及：
原发性食管小细胞癌（Primary esophageal small cell carcinoma, PESCC）是相当少见的侵袭性肿瘤，预后差。作者用IHC检测了15例浅表性PESCC，八个标志物的阳性结果如下：NSE 为100%,，Syn 100%， AE1/AE3 100%,，CD56 93.3%,，TTF-1 60%,，CgA 53.3%,，CK34betaE12 6.7%，而 CK 10/13 全为阴性。随访5年生存率为6.7%，提示生存率很低。
本文献读后思考两个问题：（1）PESCC可表达34betaE12，尽管表达率仅为6.7%，那么要问：表达34betaE12这样的病例是不是也表达P63呢？其他文献提示消化道腺癌有的可表达P63，就是食管腺的腺泡也可表达P63（表达在腺周边）。（2）PESCC患者的生存期这么短，那要不要与食管浅表型低分化鳞癌相鉴别？因为其他文献报道食管浅表型低分化鳞癌的5年生存率是86.1%，所以本例很有必要鉴别PESCC和低分化鳞癌。所以说，还要进一步做工作将二者加以区分。
Dis Esophagus. 2010 Feb;23(2):153-9. Epub 2009 Jun 9.
Superficial primary small cell carcinoma of the esophagus: clinicopathological and immunohistochemical analysis of 15 cases.
Lu J, Xue LY, Lu N, Zou SM, Liu XY, Wen P.
Department of Pathology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
Abstract
Primary esophageal small cell carcinoma (PESCC) is a relatively rare and aggressive tumor with poor prognosis. Systemic spreading and metastasis often occur at diagnosis. Although 5-year survival rate of superficial squamous cell carcinoma of the esophagus can be 86.1%, 5-year survival rate of superficial PESCC is still relatively low. This study mainly retrospectively analyzed clinicopathological and immunohistochemical features of 15 cases of superficial PESCC in our hospital from 1990 to 2004, in order to find suitable diagnostic markers and applicable therapies for this disease. The records mainly included presenting symptoms, demographics, diagnostic method, histopathology, follow-up, and therapy. Immunohistochemical staining of chromogranin A (CgA), neuron-specific enolase (NSE), synaptophysin (Syn), neuronal cell adhesion molecules (CD56), thyroid transc ription factor-1 (TTF-1), cytokeration 34betaE12 (CK34betaE12), cytokeratin (AE1/AE3), and cytokeratin 10/13 was performed. Incidence of superficial PESCC accounted for 4.8% of that of superficial carcinoma of the esophagus during the same period. Initial symptoms of all patients were dysphagia or accompanied with retrosternal pain and upper abdominal pain, and duration of these symptoms was 75 days averagely. Mean age of patients was 58.8 years old, and the male-to-female ratio was 2.75 : 1. Lesions were mainly located at middle thoracic esophagus. One, 2, and 5-year survival rates were 66.7, 33.3, and 6.7%, respectively. The median survival time was 19 months and mean survival time was 23.7 months after diagnosis. The percentages of PESCC samples with positive immunoreactivity were NSE 100%, Syn 100%, AE1/AE3 100%, CD56 93.3%, TTF-1 60%, CgA 53.3%, CK34betaE12 6.7%, and cytokeratin 10/13 0%, respectively. Our study suggested that PESCC was a rare and aggressive tumor with high malignancy. Superficial PESCC had rapid progression and poor prognosis compared with superficial squamous cell carcinoma of the esophagus at the same stage. The systemic therapy based on combination of postoperative chemotherapy and radiotherapy might be an effective approach for the treatment of superficial PESCC as a systemic disease. Higher proportion of positive labeling of NSE, Syn, AE1/AE3, CD56, TTF-1, and CgA in PESCC was valuably applied in diagnosis and differential diagnosis.
- 王军臣
以下文献采用样本配对评价了TTF-1和P63表达对小细胞性肺癌（13例）和肺低分化鳞状细胞癌（13例）的鉴别诊断意义。免疫组化标记结果显示，所有小细胞癌表达P63阴性(13/13)，而表达TTF-1呈阳性（12/13，即阳性率达92%)。相反，所有低分化鳞癌（13/13）表达P63阳性，不表达TTF-1。
结合这一文献，我们是不是要看看TTF-1的表达情况。如果本例TTF-1也是阳性，那我们还要进一步做工作来鉴别诊断。
Mod Pathol. 2006 Aug;19(8):1117-23. Epub 2006 May 5.
TTF-1 and p63 for distinguishing pulmonary small-cell carcinoma from poorly differentiated squamous cell carcinoma in previously pap-stained cytologic material.
Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston Medical School, Houston, 77030, USA.
Abstract
In histology and cell block sections, antibodies to thyroid transcription factor-1 (TTF-1) and p63 have been demonstrated to be useful markers for distinguishing between small-cell lung carcinoma and poorly differentiated pulmonary squamous cell carcinoma. In this study, we assessed the utility of TTF-1 and p63, as an antibody panel, for differentiating between these two neoplasms in previously Papanicolaou (Pap)-stained cytologic smears and cytospin slides. Twenty-six lung carcinomas (13 small-cell lung carcinomas, 13 poorly differentiated pulmonary squamous cell carcinomas) were evaluated. One or two previously 95% ethanol-fixed, Pap-stained smears or cytospin slides were selected from each case. The cytologic material from these slides was transferred to positively charged slides. Unstained recuts were obtained from the corresponding histologic specimens or cell blocks. Immunohistochemical staining for TTF-1 and p63 was performed on the paired samples from each tumor. All (13/13) small-cell lung carcinomas were negative for p63 and 92% (12/13) were positive for TTF-1. Conversely, all (13/13) poorly differentiated pulmonary squamous cell carcinomas expressed p63 and did not express TTF-1. Immunoreactivity for p63 was also noted in bronchial reserve cells and metaplastic squamous cells. The immunostaining results obtained from the cytology slides were concordant with those of the histology or cell block sections in all cases. The results of this study show that TTF-1 and p63 immunostaining can be successfully applied to previously Pap-stained cytologic material, as an antibody panel, to facilitate pathologic differentiation between small-cell lung carcinomas and poorly differentiated pulmonary squamous cell carcinomas. p63 immunostaining, however, must be interpreted in conjunction with cytomorphology to distinguish between poorly differentiated pulmonary squamous cell carcinomas and benign cellular constituents of the lung
- 王军臣
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小细胞癌是可以p63阳性的，我们昨天还有一例肺的小细胞癌是弥漫性的p63阳性。basaloid squamous cell carcinoma 不会是34be12 和ck5/6 阴性。
其实还有一个简单的IHC可做：就是pan-cytokeratin (AE1/3), 小细胞癌会出现perinuclear dot-like 染色。
至于是原发还是肺来源的，形态学本身和免疫组化学无法解决，因为其他部位的小细胞癌也可以TTF1阳性，当然TTF1阴性则更倾向于原发于食管的，因为肺的小细胞癌症是90%以上TTF1阳性。
| 以下是引用曹大夫在2011-5-11 2:46:00的发言： 小细胞癌是可以p63阳性的，我们昨天还有一例肺的小细胞癌是弥漫性的p63阳性。basaloid squamous cell carcinoma 不会是34be12 和ck5/6 阴性。 |
谢谢曹大夫的精辟点评！
欢迎曹大夫加盟国内！
欢迎来本专栏！
谢谢！
- 王军臣
