Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan.
Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
Histopathology. 2020 Jan;76(2):325-332. doi: 10.1111/his.13973. Epub 2019 Oct 30.
Colorectal adenocarcinoma with enteroblastic differentiation (CAED) is a rare malignancy, and its clinicopathological characteristics have not yet been fully elucidated. This study aimed to elucidate the clinicopathological features of CAED through immunostaining of enteroblastic lineage markers alpha-fetoprotein (AFP), glypican-3 (GPC3), and spalt-like transcription factor 4 (SALL4).
We identified five CAED cases (0.3%) from 1666 colorectal carcinomas, analysed the clinicopathological characteristics and performed immunostaining for AFP, GPC3 and SALL4. Three patients were male and two were female. All cases were located in the sigmoid colon or rectum. Histologically, all cases showed adenocarcinoma composed of cuboidal or columnar cells, with clear cytoplasm resembling the primitive gut; one case exhibited a partial hepatoid pattern. The depth of invasion was T2 and T3 in two and three cases, respectively. Lymphatic/venous invasion was found in all cases (100%), lymph node metastases in four of five cases (80%) and distant metastases in three of five cases (60%) (liver, two cases; lung, one case). Two patients died as a result of their disease during follow-up. Immunohistochemically, SALL4 and GPC3 were each positive in four of five cases, whereas one case with a hepatoid component was positive for AFP. All three CAED cases with distant metastases were GPC3-positive.
CAED was frequently located in the sigmoid colon or rectum, showed aggressive behaviour, such as lymph node metastasis and distant metastasis, and had a dismal prognosis. In addition, CAED was immunoreactive to AFP, GPC3 or SALL4, indicating that these markers may be characteristic of CAED.
具有肠胚层分化的结直肠腺癌（CAED）是一种罕见的恶性肿瘤，其临床病理特征尚未完全阐明。本研究旨在通过α胎蛋白（AFP）、高尔基糖蛋白-3（GPC3）和分裂样转录因子 4（SALL4）等肠胚层谱系标志物的免疫染色来阐明 CAED 的临床病理特征。
我们从 1666 例结直肠癌中鉴定出 5 例 CAED 病例（0.3%），分析了临床病理特征，并进行了 AFP、GPC3 和 SALL4 的免疫染色。3 例为男性，2 例为女性。所有病例均位于乙状结肠或直肠。组织学上，所有病例均表现为腺癌，由立方或柱状细胞组成，胞浆透明，类似于原始肠道；1 例表现为部分肝样形态。2 例的浸润深度为 T2，3 例为 T3。所有病例均存在淋巴管/静脉侵犯（100%），5 例中有 4 例（80%）存在淋巴结转移，5 例中有 3 例（60%）存在远处转移（肝，2 例；肺，1 例）。2 例患者在随访中因疾病死亡。免疫组化染色显示，5 例中有 4 例 SALL4 和 GPC3 均为阳性，1 例具有肝样成分的病例 AFP 阳性。所有 3 例发生远处转移的 CAED 病例均为 GPC3 阳性。
CAED 常位于乙状结肠或直肠，表现出侵袭性行为，如淋巴结转移和远处转移，且预后不良。此外，CAED 对 AFP、GPC3 或 SALL4 具有免疫反应性，表明这些标志物可能是 CAED 的特征。
