Harada Oi, Ota Hiroyoshi, Katsuyama Tsutomu, Hidaka Eiko, Ishizaka Katsuhiko, Nakayama Jun
Department of Pathology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Am J Surg Pathol. 2007 Mar;31(3):469-75. doi: 10.1097/01.pas.0000213400.64945.9e.
Esophageal gland duct adenomas are extremely rare tumors. Here, we report the case of a 75-year-old Japanese man who had undergone total gastrectomy for advanced gastric cancer. Esophageal gland duct adenoma was incidentally found in the lower esophagus. It appeared to be detached from the site of gastric cancer and was well demarcated without a capsule. Histologic analysis revealed papillary and cystic structures mainly comprising eosinophilic cells with minimum nuclear atypia. Immunohistochemical analysis revealed that the tumor were diffusely positive for the S100 protein with preserved alpha-SMA-positive myoepithelial cell layers and a characteristic cytokeratin expression pattern similar to that in normal esophageal gland ducts (CK5/6+++, CK7+++, CK17+, CK18+, CK19+++, CK20-, HMWCK+++). In addition, differentiation into the terminal duct was confirmed by a combination of mucin staining and immunohistochemical and ultrastructural examinations. This is the first report that refers to the ultrastructural findings of an esophageal gland duct adenoma and describes terminal duct differentiation. We believe that the possibility of an esophageal gland duct adenoma should be considered when diagnosing a ductal or glandular lesion of the esophagus.
食管腺管腺瘤是极为罕见的肿瘤。在此，我们报告一例75岁日本男性患者，该患者因进展期胃癌接受了全胃切除术。食管腺管腺瘤在食管下段偶然发现。它似乎与胃癌部位分离，界限清楚，无包膜。组织学分析显示主要由嗜酸性细胞组成的乳头状和囊性结构，核异型性极小。免疫组织化学分析显示肿瘤弥漫性S100蛋白阳性，肌上皮细胞层α-SMA阳性保留，且细胞角蛋白表达模式与正常食管腺管特征性相似（CK5/6+++、CK7+++、CK17+、CK18+、CK19+++、CK20-、HMWCK+++）。此外，通过黏液染色、免疫组织化学和超微结构检查相结合，证实了向终末导管的分化。这是首次提及食管腺管腺瘤超微结构发现并描述终末导管分化的报告。我们认为，在诊断食管的导管或腺性病变时，应考虑食管腺管腺瘤的可能性。
