Ge Xian, Hua Meiling, Zhan Yuan
Jiangxi Provincial Key Laboratory for Precision Pathology and Intelligent Diagnosis, Department of Pathology and Institute of Molecular Pathology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University Nanchang 330006, Jiangxi, China.
Am J Cancer Res. 2024 Aug 25;14(8):3885-3895. doi: 10.62347/RRHG4189. eCollection 2024.
This study aims to explore the clinical and pathological characteristics, prognosis, diagnosis, and differential diagnosis of gastric adenocarcinoma with enteroblastic differentiation (GAED) in elderly patients. A total of 16 cases of GAED diagnosed from August 2019 to August 2022 at the First Affiliated Hospital of Nanchang University were retrospectively collected to analyze their clinical and pathological features. A control group of 360 cases of conventional gastric adenocarcinoma diagnosed during the same period was used for comparison. Among the 16 GAED patients, 11 were male and 5 were female, with ages ranging from 64 to 89 years (median age 75.5 years). Clinical manifestations of these patients included symptoms such as abdominal pain, bloating, hematemesis, and melena. The macroscopic classification revealed 11 cases of ulcerative lesions, 4 protruded lesions, and 1 diffusely infiltrative lesion. Tumor sizes varied from 3 to 9.5 cm in diameter, with a median diameter of 4.75 cm. Microscopically, the tumor cells exhibited tubular, papillary, and cribriform arrangements, with cuboidal or columnar morphology, relatively distinct cell boundaries, and cytoplasm that appeared clear or weakly acidophilic. Immunophenotyping analysis revealed the expression of SALL4 (15/16), Glypican-3 (12/16), CDX2 (12/16), CD10 (10/16), and p53 (12 cases exhibiting mutant expression, 4 cases exhibiting wild-type expression) within the tumor cells. There was no loss of mismatch repair proteins (MLH1, PMS2, MSH2, MSH6). The Ki-67 proliferation index ranged from 50% to 95%. In comparison to conventional gastric adenocarcinoma, GAED was frequently found in the gastric antrum (P<0.001) and exhibited a higher incidence of intravascular cancer emboli (P<0.001). Significant differences were noted in the Lauren classification, invasion depth, differentiation degree (P<0.01), and macroscopic type (P<0.05). However, no significant differences were found regarding age, gender, tumor diameter, neural invasion, or lymph node metastasis (P>0.05). The postoperative follow-up ranging from 5 to 29 months revealed one death and 15 cases of disease-free survival. GAED is a special subtype of gastric adenocarcinoma characterized by a combination of embryonal and intestinal differentiation immunophenotypes, as well as its increased propensity for biological invasion. Accurate identification of GAED is crucial in pathological practice, as it helps differentiate between GAED and conventional adenocarcinoma and aids in the evaluation of tumor malignancy. Furthermore, it is imperative to conduct a differential diagnosis that involves hepatoid adenocarcinoma, yolk sac tumor-like adenocarcinoma, and metastatic hepatocellular carcinoma.
本研究旨在探讨老年胃腺癌伴成胚细胞分化（GAED）的临床病理特征、预后、诊断及鉴别诊断。回顾性收集2019年8月至2022年8月在南昌大学第一附属医院诊断的16例GAED病例，分析其临床病理特征。选取同期诊断的360例传统胃腺癌作为对照组进行比较。16例GAED患者中，男性11例，女性5例，年龄64至89岁（中位年龄75.5岁）。这些患者的临床表现包括腹痛、腹胀、呕血和黑便等症状。大体分类显示溃疡型病变11例，隆起型病变4例，弥漫浸润型病变1例。肿瘤直径3至9.5 cm，中位直径4.75 cm。镜下，肿瘤细胞呈管状、乳头状和筛状排列，形态为立方或柱状，细胞边界相对清晰，胞质清亮或弱嗜酸性。免疫表型分析显示肿瘤细胞中SALL4（15/16）、Glypican-3（12/16）、CDX2（12/16）、CD10（10/16）表达，p53有12例呈突变型表达，4例呈野生型表达。错配修复蛋白（MLH1、PMS2、MSH2、MSH6）无缺失。Ki-67增殖指数为50%至95%。与传统胃腺癌相比，GAED多见于胃窦部（P<0.001），血管内癌栓发生率更高（P<0.001）。在Lauren分型、浸润深度、分化程度（P<0.01）和大体类型（P<0.05）方面存在显著差异。然而，在年龄、性别、肿瘤直径、神经侵犯或淋巴结转移方面未发现显著差异（P>0.05）。术后随访5至29个月，1例死亡，15例无病生存状态。GAED是胃腺癌的一种特殊亚型，其特征为胚胎性和肠型分化免疫表型的组合以及生物侵袭倾向增加。在病理实践中准确识别GAED至关重要，有助于鉴别GAED与传统腺癌，并辅助评估肿瘤恶性程度。此外，必须进行鉴别诊断，包括肝样腺癌、卵黄囊瘤样腺癌和转移性肝细胞癌。
