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鼻窦腺癌:肠道型和非肠道型表型组织发生学差异的证据

Sinonasal adenocarcinoma: evidence for histogenetic divergence of the enteric and nonenteric phenotypes.

作者信息

Choi Hong-Ran, Sturgis Erich M, Rashid Asif, DeMonte Franco, Luna Mario A, Batsakis John G, El-Naggar Adel K

机构信息

Chonnam National University, Kwangju, Korea.

出版信息

Hum Pathol. 2003 Nov;34(11):1101-7. doi: 10.1053/j.humpath.2003.08.024.

Abstract

Adenocarcinomas of nonsalivary origin represent approximately 10% to 20% of all sinonasal malignancies and are characterized by varying histopathologic features and uncertain histogenesis. To better understand the histogenesis and phenotypic heterogeneity of these tumors, we performed immunohistochemical analyses for cytokeratin (CK) 7 and CK20 on 12 primary sinonasal adenocarcinomas (SNACs) representing the histopathologic spectrum of these tumors, adjacent normal mucosa, and 2 metastatic adenocarcinomas from colonic primaries. The demographic and clinicopathologic characteristics of our cohort were similar to those in previously published series. Our results indicate that histologically normal respiratory-type epithelium and submucosal seromucous glands show restricted reactivity to CK7. Epithelial metaplasia of surface epithelium associated with enteric SNACs was accompanied by a conversion from CK7 positivity to CK20 positivity. All primary enteric-type carcinomas and the 2 colonic metastases were reactive to CK20, but all nonenteric-type tumors were negative for CK20 (P=0.003) and positive for CK7. In some of the enteric types, coexpression of CK7 and CK20 was noted. We conclude that (1) nonenteric-type (seromucinous) adenocarcinoma may originate directly from surface respiratory-type epithelium or from seromucous glands, (2) metaplastic transformation of surface respiratory to enteric-type epithelium precedes the development of enteric adenocarcinoma, and (3) coordinate analyses of CK7 and CK20 reactivity may aid the differential diagnosis of adenocarcinoma in the sinonasal tract.

摘要

非涎腺来源的腺癌约占所有鼻窦恶性肿瘤的10%至20%,其组织病理学特征各异,组织发生尚不明确。为更好地了解这些肿瘤的组织发生和表型异质性,我们对12例原发性鼻窦腺癌(SNAC)、相邻正常黏膜以及2例来自结肠原发性的转移性腺癌进行了细胞角蛋白(CK)7和CK20的免疫组化分析,这12例原发性鼻窦腺癌代表了这些肿瘤的组织病理学谱。我们队列的人口统计学和临床病理特征与先前发表系列中的特征相似。我们的结果表明,组织学上正常的呼吸型上皮和黏膜下浆液黏液腺对CK7的反应性有限。与肠道型SNAC相关的表面上皮化生伴随着从CK7阳性到CK20阳性的转变。所有原发性肠道型癌和2例结肠转移癌对CK20呈反应性,但所有非肠道型肿瘤对CK20呈阴性(P = 0.003),对CK7呈阳性。在一些肠道型肿瘤中,观察到CK7和CK20的共表达。我们得出结论:(1)非肠道型(浆液黏液性)腺癌可能直接起源于表面呼吸型上皮或浆液黏液腺;(2)表面呼吸型上皮向肠道型上皮的化生转变先于肠道腺癌的发生;(3)CK7和CK20反应性的协同分析可能有助于鼻窦腺癌的鉴别诊断。

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