Saeki T, Mandai K, Moriwaki S, Yamagami K, Sakamoto N, Takiyama W, Takashima S
Department of Clinical Research, National Shikoku Cancer Center Hospital, Matsuyama, Japan.
Surg Today. 1996;26(4):276-80. doi: 10.1007/BF00311588.
A 70-year-old man who had undergone esophagectomy with reconstructive surgery using a portion of the stomach 5 years earlier for esophageal cancer was admitted to our hospital after a routine endoscopy and histological examination of a biopsy specimen revealed poorly differentiated adenocarcinoma in the stomach. A gastrectomy and intrathoracic esophagojejunostomy was performed on January 20, 1993; however, the patient suffered a cerebral infarction and died of septic shock on April 9, 1993. At autopsy, metastatic tumors were macroscopically observed in various organs, including a bone tumor measuring 1.0 cm in diameter in the L4 vertebra. To clarify the origin of the bone tumor, we conducted histological and immunohistochemical examinations. Histological examination revealed a mixture of osteoclast-like giant cells (OGCs) and poorly differentiated adenocarcinoma cells, although no histologic features of OGCs were observed either in a primary site or in any of the multiple metastatic lesions. On immunohistochemistry, adenocarcinoma cells in the bone stained positively for the carcinoembryonic antigen (CEA), whereas no staining for CEA was observed in the OGCs which demonstrated negative staining for all the antigens of epithelial markers. These findings led us to conclude that this bone tumor had metastasized from the stomach cancer and that the OGCs may have originated from mesenchymal cells reacting to the adenocarcinoma cells.
一名70岁男性，5年前因食管癌接受了使用部分胃进行重建手术的食管切除术。在一次常规内镜检查及活检标本的组织学检查显示胃内存在低分化腺癌后，他被收治入我院。1993年1月20日进行了胃切除术及胸内食管空肠吻合术；然而，患者于1993年4月9日发生脑梗死并死于感染性休克。尸检时，在包括L4椎体处一个直径1.0 cm的骨肿瘤在内的多个器官中肉眼观察到转移性肿瘤。为明确骨肿瘤的起源，我们进行了组织学和免疫组化检查。组织学检查显示破骨细胞样巨细胞（OGCs）和低分化腺癌细胞混合存在，尽管在原发部位或任何一个多发转移病灶中均未观察到OGCs的组织学特征。免疫组化检查显示，骨内的腺癌细胞癌胚抗原（CEA）染色呈阳性，而OGCs中未观察到CEA染色，且OGCs对所有上皮标志物抗原染色均为阴性。这些发现使我们得出结论，该骨肿瘤为胃癌转移所致，且OGCs可能起源于对腺癌细胞产生反应的间充质细胞。
