Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, 010-8543, Japan; Faculty of Medicine, Akita University, Akita, 010-8543, Japan.
Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, 010-8543, Japan.
Hum Pathol. 2017 Dec;70:27-34. doi: 10.1016/j.humpath.2017.09.009. Epub 2017 Sep 29.
Adenocarcinomas showing fetal gut-like (enteroblastic) differentiation can arise in a variety of organs and are frequently accompanied by an elevated serum α-fetoprotein (AFP) level. However, no study has investigated fetal gut-like differentiation in gallbladder cancer in detail. Herein, we performed morphological and immunohistochemical analyses of fetal gut-like differentiation in 49 consecutive gallbladder cancer cases. The expression of Sal-like protein 4 (SALL4), an embryonic stem cell marker reported to represent fetal gut-like differentiation, as well as other oncofetal proteins, including glypican-3 (GPC3) and AFP, was assessed. We found 1 case of fetal gut-like adenocarcinoma that coexisted with conventional-type adenocarcinoma. The fetal gut-like adenocarcinoma component revealed diffuse immunoreactivity for SALL4 and partial positivity for AFP, whereas the conventional-type adenocarcinoma component was negative. We also found 2 poorly differentiated adenocarcinomas with hepatoid morphology and 1 clear cell carcinoma, none of which showed SALL4 positivity. In other conventional-type adenocarcinomas, focal immunoreactivity for SALL4 and GPC3 was occasionally observed. The overall positivity rates for SALL4 and GPC3 were 12.2% (6/49) and 16.3% (8/49), respectively. SALL4 and GPC3 expression was not associated with clinicopathological factors, including T category, lymphovascular invasion, and lymph node metastases. In conclusion, fetal gut-like adenocarcinoma was found in 2% of our gallbladder cancer series. We conclude that fetal gut-like adenocarcinoma is a distinct histological subtype of gallbladder cancer, characterized by SALL4 expression.
具有胎儿肠样（肠胚层）分化的腺癌可发生于多种器官，常伴有血清 α-胎蛋白（AFP）水平升高。然而，尚无研究详细探讨过胆囊癌中的胎儿肠样分化。在此，我们对 49 例连续的胆囊癌病例进行了胎儿肠样分化的形态学和免疫组织化学分析。评估了胚胎干细胞标志物 Sal-like 蛋白 4（SALL4）的表达，该标志物被报道代表胎儿肠样分化，以及其他癌胚蛋白，包括 Glypican-3（GPC3）和 AFP。我们发现 1 例与常规型腺癌共存的胎儿肠样腺癌。胎儿肠样腺癌成分表现为弥漫性 SALL4 免疫反应性和 AFP 的部分阳性，而常规型腺癌成分则为阴性。我们还发现 2 例具有肝细胞形态的低分化腺癌和 1 例透明细胞癌，它们均不表现为 SALL4 阳性。在其他常规型腺癌中，偶尔观察到 SALL4 和 GPC3 的局灶性免疫反应性。SALL4 和 GPC3 的总阳性率分别为 12.2%（6/49）和 16.3%（8/49）。SALL4 和 GPC3 的表达与包括 T 分期、血管淋巴管侵犯和淋巴结转移在内的临床病理因素无关。总之，我们的胆囊癌系列中发现了 2%的胎儿肠样腺癌。我们的结论是，胎儿肠样腺癌是胆囊癌的一种独特组织学亚型，其特征是 SALL4 的表达。
