Mochizuki Kunio, Kondo Tetsuo, Tahara Ippei, Inoue Tomohiro, Kasai Kazunari, Oishi Naoki, Nakazawa Tadao, Katoh Ryohei
Department of Pathology, University of Yamanashi, Yamanashi, Japan.
Department of Pathology, University of Yamanashi, Yamanashi, Japan.
Pathol Res Pract. 2015 Oct;211(10):801-4. doi: 10.1016/j.prp.2015.04.013. Epub 2015 May 21.
We describe a case of signet ring cell carcinoma of the non-ampullary duodenum in an 86-year-old woman. Endoscopic examination revealed a fungating lesion (Borrmann classification; type 2) on the anterior wall of the descending duodenum (second part). Pylorus-preserving pancreaticoduodenectomy and lymphadenectomy were performed. The tumor (pT3 and pN0) was predominantly composed of signet ring cells, characterized by a central, optically clear, globoid droplet of cytoplasmic mucin with an eccentrically placed nucleus. The cells were positive for periodic acid Schiff with diastase and Alcian blue pH 2.5. On immunohistochemical examination, MUC-5AC, MUC-2 and CDX2 were diffusely positive, and MUC-6 was negative in the tumor cells, which consisted of mixed gastric foveolar and intestinal phenotypes. Cytokeratin 7 was focally positive, but cytokeratin 20 was negative. Nuclear staining of p53 was diffusely and weakly positive. Signet ring cell carcinoma occurring in the non-ampullary duodenum might derive from duodenal goblet cells with MUC-5AC expression.
我们报告一例86岁女性非壶腹十二指肠印戒细胞癌的病例。内镜检查发现十二指肠降部（第二部）前壁有一蕈伞状病变（Borrmann分类；2型）。施行保留幽门的胰十二指肠切除术及淋巴结清扫术。肿瘤（pT3和pN0）主要由印戒细胞组成，其特征为中央有一个光学透明的球状胞质黏液滴，细胞核偏位。细胞对淀粉酶消化后的过碘酸希夫反应及pH 2.5的阿尔辛蓝呈阳性。免疫组化检查显示，肿瘤细胞中MUC-5AC、MUC-2和CDX2弥漫阳性，MUC-6阴性，肿瘤细胞由胃小凹和肠型混合表型组成。细胞角蛋白7局灶阳性，但细胞角蛋白20阴性。p53核染色弥漫弱阳性。发生于非壶腹十二指肠的印戒细胞癌可能起源于表达MUC-5AC的十二指肠杯状细胞。
