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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
