考虑为癌或神经内分泌癌。

IHC：CK5/6、CK14、CK（低分子量）、CgA、Syn、CD117、CD34、Vimentin、Ki-67

Adenosquamous carcinoma vs. high-grade neuroendocrine carcinoma with squamous cell differentiation. Clinically, these two entities share many similar features: they are rare, consisting of less than 1% of gastric cancer. Both usually deeply invade, with frequent lymphovascular invasion, and prognosis is very poor.

 腺鳞癌和高级别神经内分泌癌伴有鳞状分化。临床上，这两种病变具有很多相似特征：均少见，构成比例均不到胃癌的1%。二者均常浸润较深，常有脉管侵犯，预后很差。

In adenosquamous carcinoma. typically, IHC will highlights two cell populations: squamoid area with cells positive for CK5/6 and p63,  and poorly differentiated/glandular area with cells positive for MOC-31+, CDX-2 and MUC-5AC.

 腺鳞癌中，免疫表型常显示两种细胞类型：鳞状细胞区域，常呈CK5/6 and p63阳性；低分化或腺样区域，常呈MOC-31+, CDX-2 and MUC-5AC阳性。

Chromogranin and synaptophysin could be focally weakly positive. However if they are diffusely positive. Then it is high-grade neuroendocrine carcinoma with focal squamous cell differentiation.

 CgA和syn可局灶弱阳性。如果二者弥漫强阳性时，那么即为高级别神经内分泌癌伴有局灶区域鳞状分化。

Bottom line: it is a high-grade cancer. IHC panel will help to classify it.

本例至少为高级别癌，免疫表型谱将有助于进一步分类。

 1、低分化腺癌？

2、神经内分泌肿瘤？

3、血管周细胞肿瘤/血管球瘤？

4、颗粒细胞瘤？

 首先考虑的是低分化腺癌，伴或不伴神经内分泌分化（神经内分泌标记局部阳性或非弥漫强阳性）；

如果神经内分泌的标记是弥漫强阳性，则为神经内分泌癌。