Hamilton K, Chiappori A, Olson S, Sawyers J, Johnson D, Washington K
Department of Pathology, Nashville Veterans Affairs Medical Center, Tennessee, USA.
Mod Pathol. 2000 May;13(5):475-81. doi: 10.1038/modpathol.3880081.
Neuroendocrine differentiation is common in adenocarcinomas of the stomach and colon and may be associated with a slightly better prognosis in gastric adenocarcinoma. We studied neuroendocrine differentiation in esophageal adenocarcinomas and associated Barrett's esophagus (BE) to determine association with patient outcome. Fifty-eight cases of esophageal adenocarcinoma (15 biopsies, 43 resections) from 52 patients were stained with a monoclonal antibody to chromogranin (CG). Medical records were reviewed for tumor stage, response to therapy, and patient survival. Thirty-two patients received radiation and chemotherapy, and four received radiation. Twelve of 58 (20.7%) esophageal adenocarcinomas contained scattered CG-positive cells. Tumors with CG-positive cells were moderately to poorly differentiated, and many consisted of large cribriform glands, similar to intestinal-type adenocarcinomas. One case of small cell carcinoma of the esophagus was weakly CG positive; another was negative. Neuroendocrine differentiation was retained in lymph node metastases in two cases but lost in three other cases. In 10 CG-negative primary tumors, lymph node metastases were also negative. For five of six patients with paired biopsy/resection specimens, no CG-positive cells were seen in either specimen; one patient had CG-positive cells only in the resection. There was no difference in tumor stage at surgery or survival time between CG-positive and CG-negative tumors. BE was present in 34 cases and contained CG-positive cells in 21 of 34 (61.8%). Low-grade dysplasia contained CG-positive cells in 11 of 14 cases (78.6%) and high-grade dysplasia in 3 of 6 cases. Fourteen of 21 (66.7%) adenocarcinomas associated with CG-positive BE were negative for CG. In summary, neuroendocrine differentiation is common in BE and is retained in low- and high-grade dysplasia but is usually lost in esophageal adenocarcinoma. The presence of scattered neuroendocrine cells does not affect patient outcome.
神经内分泌分化在胃和结肠腺癌中很常见，在胃腺癌中可能与稍好的预后相关。我们研究了食管腺癌及相关的巴雷特食管（BE）中的神经内分泌分化，以确定其与患者预后的关系。对52例患者的58例食管腺癌（15例活检，43例切除标本）用嗜铬粒蛋白（CG）单克隆抗体进行染色。查阅病历以了解肿瘤分期、治疗反应和患者生存情况。32例患者接受了放疗和化疗，4例接受了放疗。58例食管腺癌中有12例（20.7%）含有散在的CG阳性细胞。有CG阳性细胞的肿瘤为中分化至低分化，许多由大筛状腺体组成，类似于肠型腺癌。1例食管小细胞癌CG弱阳性；另1例为阴性。2例病例的淋巴结转移灶中保留了神经内分泌分化，但另外3例病例中丢失。在10例CG阴性的原发性肿瘤中，淋巴结转移灶也为阴性。在6例配对活检/切除标本的患者中，5例患者的两种标本均未见CG阳性细胞；1例患者仅在切除标本中有CG阳性细胞。CG阳性和CG阴性肿瘤在手术时的肿瘤分期或生存时间上没有差异。34例患者存在BE，其中21例（61.8%）含有CG阳性细胞。低级别异型增生的14例病例中有11例（78.6%）含有CG阳性细胞，高级别异型增生的6例病例中有3例含有CG阳性细胞。与CG阳性BE相关的21例腺癌中有14例（66.7%）CG阴性。总之，神经内分泌分化在BE中很常见，在低级别和高级别异型增生中保留，但在食管腺癌中通常丢失。散在神经内分泌细胞的存在不影响患者预后。
