Staren E D, Gould V E, Jansson D S, Hyser M, Gooch G T, Economou S G
Department of General Surgery, Rush Medical College, Chicago, Illinois 60612.
Am Surg. 1990 Jul;56(7):412-9.
The diagnosis of "poorly differentiated" carcinoma was made in 47 of 683 colon cancers on the basis of conventional light microscopy which showed poorly defined glands, solid architecture or variable admixtures thereof. Samples from 44 of these 47 tumors were assessed by immunohistochemical analysis for the presence of neuroendocrine (NE) antigens. Paraffin sections were immunostained with antibodies to NSE, chromogranin, serotonin, VIP, substance P and somatostatin. Additional sections were also stained with monoclonal antibody (Mab) A-80 that recognizes a glycoprotein related to exocrine (EX) differentiation. Based on our findings, the tumors were phenotypically reclassified as follows: I) pure EX (n = 8), II) pure NE (n = 4), III) mixed EX-NE carcinomas (n = 23), and IV) predominantly EX carcinomas with occasional NE cells (n = 9). Survival among groups II and III appeared to be less than group I and survival in group IV was significantly less than group I. Survival among the four pure NE (group II) and 11 predominantly NE mixed carcinomas (group III) taken together was significantly less than the pure EX carcinomas. This study indicates: 1) The incidence of NE differentiation in tumors of the colon and rectum is higher than previously believed. 2) The poorly differentiated colon carcinomas comprise four distinct groups: pure EX, pure NE, mixed EX-NE carcinomas, and predominantly EX carcinomas with a NE cell subpopulation. 3) The presence of NE differentiation or of a NE cell subpopulation in colon carcinoma appears to be associated with a poorer prognosis.
在683例结肠癌中，47例基于传统光学显微镜检查诊断为“低分化”癌，这些肿瘤显示腺管界限不清、实性结构或二者混合。对这47例肿瘤中的44例样本进行免疫组化分析，以检测神经内分泌（NE）抗原的存在。石蜡切片用抗神经元特异性烯醇化酶（NSE）、嗜铬粒蛋白、5-羟色胺、血管活性肠肽（VIP）、P物质和生长抑素的抗体进行免疫染色。另外的切片还用识别与外分泌（EX）分化相关糖蛋白的单克隆抗体（Mab）A-80进行染色。根据我们的研究结果，这些肿瘤在表型上重新分类如下：I）纯外分泌型（n = 8），II）纯神经内分泌型（n = 4），III）外分泌-神经内分泌混合型癌（n = 23），IV）以外分泌为主伴偶尔神经内分泌细胞的癌（n = 9）。II组和III组的生存率似乎低于I组，IV组的生存率显著低于I组。将四个纯神经内分泌型（II组）和11个以外分泌为主的神经内分泌混合型癌（III组）合并在一起的生存率显著低于纯外分泌型癌。本研究表明：1）结肠和直肠癌肿瘤中神经内分泌分化的发生率高于先前认为的。2）低分化结肠癌包括四个不同的组：纯外分泌型、纯神经内分泌型、外分泌-神经内分泌混合型癌，以及以外分泌为主伴神经内分泌细胞亚群的癌。3）结肠癌中神经内分泌分化或神经内分泌细胞亚群的存在似乎与较差的预后相关。
