结肠鳞癌2例和腺鳞癌2例临床病理学特征分析

doi:10.16150/j.1671-2870.2023.01.007

摘要/Abstract

摘要：

目的: 探讨结肠鳞癌和腺鳞癌的临床病理学特征。方法: 回顾性分析2例结肠鳞癌和2例结肠腺鳞癌患者的临床病理特征和预后。结果: 4例患者中，男性1例，女性3例，年龄为29~76岁。2例伴血清糖类抗原19-9增高，分别为88.25 ng/mL和553.13 ng/mL；2例伴血清癌胚抗原增高，分别为116.39 U/mL和37.22 U/mL。3例患者的肿瘤发生于升结肠，1例发生于降结肠。镜下，4例鳞癌区域，肿瘤组织排列成不规则巢团状或片状，肿瘤细胞多角形或不规则形，细胞嗜酸异型，且表达P40和P63；2例腺鳞癌的腺癌区域，肿瘤组织排列成不规则腺管状或筛孔状，细胞核深染异型，且肿瘤细胞表达CAM5.2和CK20；3例表达P16。1例合并血吸虫感染。无患者感染人乳头瘤病毒，3例存在错配修复蛋白表达缺失，3例存在KRAS基因突变。中位随访期为42个月，1例患者于术后16.4个月死亡，其余3例存活，无复发。结论: 鳞癌和腺鳞癌是肠癌极罕见的组织病理学类型，生物学行为不良，多伴错配修复蛋白表达缺失和KRAS基因突变。根治性手术切除可使患者获得良好预后。

关键词: 鳞状细胞癌, 肠癌, 预后

Abstract:

Objective: To investigate the clinicopathological features of colon squamous cell carcinoma and adenosquamous carcinoma. Methods: The clinicopathological data and prognosis of 4 patients with colonic squamous cell carcinoma or adenosquamous carcinoma were collected retrospectively. Results: There were 1 male and 3 female, and the age ranged from 29 to 76 years old. Serum CA19-9 was increased in 2 cases, which were 88.25 ng/mL and 553.13 ng/mL, respectively. Serum CEA increased in 2 cases, which were 116.39 U/mL and 37.22 U/mL, respectively. Three cases occurred in ascending colon and 1 case in descending colon. Microscopically, the squamous cell carcinoma of 4 cases was arranged into irregular nesting or flake shape, the tumor cells were polygonal or irregular, the cells were eosinophilic and expressed P40 and P63, while the adenocarcinoma of 2 adenosquamous carcinoma cases was arranged into irregular glandular tubules or cribriform, and the cell nucleus was deeply stained and expressed CAM5.2 and CK20. P16 was expressed in 3 cases. One case was complicated with schistosome. No patient was with human papilloma virus infection. Mismatch repair protein absently expressed in 3 cases. Three cases were complicated with KRAS gene mutation. At the last of follow-up, 1 patient died at 16.4 months after surgery, and the remaining 3 patients survived without recurrence (median follow-up time: 42 months). Conclusions: Squamous cell carcinoma and adenosquamous carcinoma are rare histopathological types of colorectal cancer with poor biological behavior, often accompanied by loss of mismatch repair protein expression and KRAS gene mutation. Radical resection is an effective way to obtain a good prognosis.

Key words: Squamous cell carcinoma, Colorectal cancer, Prognosis

中图分类号:

R735.3

王瀚, 陆海迪, 王雷, 丛文铭, 郑建明, 白辰光. 结肠鳞癌2例和腺鳞癌2例临床病理学特征分析[J]. 诊断学理论与实践, 2023, 22(01): 44-49.

WANG Han, LU Haidi, WANG Lei, CONG Wenming, ZHENG Jianming, BAI Chenguang. Clinicopathological features of 2 cases of squamous cell carcinoma and 2 cases of adenosquamous carcinoma[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(01): 44-49.

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Case	Sex	Age	Family history	Symptoms and signs	CA19-9 (ng/mL)	CEA (U/mL)	TNM classification
1	Female	29	No	Distension and pain in right upper abdomen for 6 months, worsening with melena for 2 weeks	88.25	1.85	T₃N₁M₀
2	Female	70	No	Bloody stool for 2 weeks	2.00	116.39	T₃N₀M₀
3	Male	76	No	Dull pain in lower abdomen for 2 months	7.97	2.89	T₄N₁M₀
4	Female	52	Yes	Intermittent pain in left upper abdomen for 1 month	553.13	37.22	T₄N₁M₀

Case	Location	Diameter (cm)	pTNM classification	Number of lymph nodes	Vessel carcinoma embolus	Perineural invasion	Diagnosis
1	Ascending colon	5.0	T₃N₀M₀	18	No	No	Squamous cell carcinoma
2	Ascending colon	6.0	T₃N₀M₀	16	No	No	Adenosquamous carcinoma (main component: adenocarcinoma)
3	Ascending colon	7.5	T_4aN₀M₀	25	Yes	No	Squamous cell carcinoma
4	Descending colon	10.0	T_4aN₀M₀	16	No	No	Adenosquamous carcinoma (main component: squamous cell carcinoma)