Ikeda Hideyuki, Kukitsu Takehiro, Johmen Wataru, Nakamura Hajime, Yamauchi Natumi, Ishikawa Kazuma, Saikawa Takashi, Noda Sayaka, Saitoh Tadanori, Ueno Yoshinori, Noda Yuuya, Yamazaki Sayuki, Kuroda Yoshikazu, Koshiko Susumu, Sasagawa Yutaka
Divisions of Surgical Pathology, Rumoi City Hospital, Rumoi, Japan.
Divisions of Internal Medicine, Rumoi City Hospital, Rumoi, Japan.
Case Rep Oncol. 2014 Sep 3;7(3):611-20. doi: 10.1159/000367583. eCollection 2014 Sep.
We report a case of gastric invasive micropapillary carcinoma (IMPC) in an 86-year-old female patient. She was admitted to our hospital with a chief complaint of bloody emesis. Upper gastrointestinal endoscopy found a gastric adenocarcinoma at the antrum. The biopsy specimens showed moderately differentiated adenocarcinoma with invasive small tumor nests. Distal gastrectomy with systematic lymph node dissection demonstrated that the tumor had IMPC through a pathological examination. Despite the depth of tumor invasion (the submucosa), extensive lymph node metastases were observed. Anti-D2-40 immunostaining revealed numerous infiltrating tumor cell nests in the lymphatic vessels, which could explain subsequent multiple lymph node metastases. The adenocarcinoma showed intestinal phenotypes by several immunohistochemical studies. One of these antibodies (CD10) clearly demonstrated the inverted apical-basal (inside-out) pattern of IMPC, whereas it showed an ordinary pattern in intestinal metaplasia adjacent to the tumor. Furthermore, genetic analysis by direct sequencing revealed a point mutation in the exon 5 of TP53 in the tumor. The mutation presumably harbors a missense mutation from Arg to His at the codon 175 (R175H). R175H has been previously described as a 'gain-of-function' mutation with a high invasive or metastatic potential in several types of cancers. In summary, this is one of the first reported cases of gastric IMPC with intestinal phenotypes harboring a TP53 R175H mutation in the literature.
我们报告一例86岁女性胃浸润性微乳头状癌（IMPC）患者。她因呕血为主诉入院。上消化道内镜检查发现胃窦部有胃腺癌。活检标本显示为中度分化腺癌，有浸润性小肿瘤巢。远端胃切除术加系统性淋巴结清扫术后病理检查显示肿瘤为IMPC。尽管肿瘤浸润深度为黏膜下层，但仍观察到广泛的淋巴结转移。抗D2-40免疫染色显示淋巴管内有大量浸润性肿瘤细胞巢，这可以解释随后的多处淋巴结转移。通过多项免疫组织化学研究，该腺癌显示出肠型表型。其中一种抗体（CD10）清楚地显示了IMPC的顶端-基底倒置（由内向外）模式，而在肿瘤邻近的肠化生中则显示出普通模式。此外，直接测序的基因分析显示肿瘤中TP53基因第5外显子存在一个点突变。该突变推测为密码子175处由精氨酸突变为组氨酸的错义突变（R175H）。R175H先前在几种癌症中被描述为具有高侵袭或转移潜能的“功能获得性”突变。总之，这是文献中首次报道的具有肠型表型且携带TP53 R175H突变的胃IMPC病例之一。
