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胃腺癌与十二指肠神经内分泌细胞癌同时发生：复合肿瘤还是碰撞瘤？

Concurrent occurrence of gastric adenocarcinoma and duodenal neuroendocrine cell carcinoma: a composite tumour or collision tumours ?

作者信息

Fukui H, Takada M, Chiba T, Kashiwagi R, Sakane M, Tabata F, Kuroda Y, Ueda Y, Kawamata H, Imura J, Fujimori T

机构信息

Department of Pathology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan.

出版信息

Gut. 2001 Jun;48(6):853-6. doi: 10.1136/gut.48.6.853.

DOI:10.1136/gut.48.6.853
PMID:11358908
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1728320/
Abstract

BACKGROUND

Neuroendocrine cell (NEC) carcinoma is occasionally accompanied by adenocarcinoma but the relationship between these two morphologically distinct tumours is unclear. Two hypotheses have arisen regarding the mechanism for the association of adenocarcinoma and NEC carcinoma. One is that both are derived from a common multipotential epithelial stem cell. The second hypothesis is that adenocarcinoma and NEC carcinoma arise from a multipotential epithelial stem cell and a primitive NEC, respectively.

AIMS

To elucidate the relationship between the two histologically distinct tumours, adenocarcinoma of the stomach and NEC carcinoma of the duodenum.

PATIENT/METHODS: We present a case in which the tumour extended across the pyloric ring, the gastric portion of which revealed adenocarcinoma while the duodenal portion showed argyrophil NEC carcinoma. The two histologically distinct lesions of the tumour were examined by immunohistochemistry and genetic analysis of p53.

RESULTS

The gastric region was negative for chromogranin A staining but positive for carcinoembryonic antigen (CEA) staining. In contrast, the duodenal region was positive for chromogranin A but negative for CEA. All tumour regions showed a point mutation in p53 gene at exon 7 (GGC (glycine)-->GTC (valine) at codon 245). The distal portion of the duodenal tumour showed an additional point mutation in p53 gene at exon 5 (GCC (alanine)-->GTC (valine) at codon 129).

CONCLUSIONS

The two histologically distinct tumours, adenocarcinoma of the stomach and NEC carcinoma of the duodenum, appear to be derived from a common epithelial cell.

摘要

背景

神经内分泌细胞（NEC）癌偶尔会伴有腺癌，但这两种形态学上不同的肿瘤之间的关系尚不清楚。关于腺癌与NEC癌关联的机制出现了两种假说。一种假说是两者均源自共同的多能上皮干细胞。第二种假说是腺癌和NEC癌分别源自多能上皮干细胞和原始NEC。

目的

阐明两种组织学上不同的肿瘤，即胃腺癌和十二指肠NEC癌之间的关系。

患者/方法：我们报告一例肿瘤跨越幽门环的病例，其中胃部分显示为腺癌，而十二指肠部分显示为嗜银NEC癌。通过免疫组织化学和p53基因分析对肿瘤的两个组织学上不同的病变进行了检查。

结果

胃区域嗜铬粒蛋白A染色阴性，但癌胚抗原（CEA）染色阳性。相比之下，十二指肠区域嗜铬粒蛋白A阳性，但CEA阴性。所有肿瘤区域在p53基因第7外显子均显示点突变（密码子245处GGC（甘氨酸）→GTC（缬氨酸））。十二指肠肿瘤的远端部分在p53基因第5外显子显示另一个点突变（密码子129处GCC（丙氨酸）→GTC（缬氨酸））。

结论

两种组织学上不同的肿瘤，即胃腺癌和十二指肠NEC癌，似乎源自共同的上皮细胞。