Caraşca Cosmin, Simion George, Nechifor-Boilă Adela Corina, Boeriu Alina Mioara, Dobru Ecaterina Daniela
Department of Gastroenterology, University of Medicine and Pharmacy of Tirgu Mures, Romania;
Rom J Morphol Embryol. 2018;59(1):311-315.
Primary duodenal cancer is a rare entity accounting for only 0.3% of all gastrointestinal cancers. Histopathologically, most duodenal cancers are mucin-producing adenocarcinomas, 34% being poorly differentiated. Signet-ring cell (SRC) carcinoma is extremely uncommon in the duodenum. Herein, we report a rare case of SRC carcinoma associated with poorly differentiated adenocarcinoma of the non-ampullary duodenum in a 74-year-old woman. The patient was admitted to the hospital for persistent epigastric pain, significant weight loss and hypochromic microcytic anemia. Esophago-gastro-duodenoscopy revealed a protruded lesion, with ulceration in the second portion of the duodenum, above the papilla. The patient was referred to surgery and pancreatico-duodenectomy with lymph node dissection was performed. The tumor consisted predominately of SRCs, Periodic Acid Schiff (PAS)-Alcian blue positive. The tumor cells were CDX2, cytokeratin (CK) 7 and CK 18/8 positive, which suggested a primary upper gastrointestinal tract site of origin. Immunostaining for mucin (MUC) 2 and MUC5AC was also positive demonstrating the duodenal goblet cells differentiation with a mixed gastric-foveolar and intestinal phenotype. Based on the morphological features and the immunohistochemical profile, a diagnosis of SRC carcinoma associated with poorly differentiated adenocarcinoma of the non-ampullary duodenum was set.
原发性十二指肠癌是一种罕见的疾病，仅占所有胃肠道癌症的0.3%。组织病理学上，大多数十二指肠癌是产生黏液的腺癌，34%为低分化癌。印戒细胞（SRC）癌在十二指肠中极为罕见。在此，我们报告一例74岁女性的罕见病例，该病例为非壶腹十二指肠SRC癌合并低分化腺癌。患者因持续性上腹部疼痛、显著体重减轻和低色素小细胞性贫血入院。食管胃十二指肠镜检查发现十二指肠第二部乳头上方有一突出病变，并伴有溃疡。患者接受手术治疗，行胰十二指肠切除术并清扫淋巴结。肿瘤主要由SRC组成，过碘酸希夫（PAS）-阿尔辛蓝染色阳性。肿瘤细胞CDX2、细胞角蛋白（CK）7和CK 18/8阳性，提示原发于上消化道。黏蛋白（MUC）2和MUC5AC免疫染色也呈阳性，显示十二指肠杯状细胞分化，具有胃小凹和肠混合表型。根据形态学特征和免疫组化结果，诊断为非壶腹十二指肠SRC癌合并低分化腺癌。
