Kim H, Jung J K, Park J H, Park C
Department of Pathology, Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
J Korean Med Sci. 1996 Apr;11(2):137-43. doi: 10.3346/jkms.1996.11.2.137.
It has recently been shown that nearly all cancers from hereditary nonpolyposis colorectal cancer syndrome (HNPCC), as well as a subset of sporadic colorectal cancers, have DNA replication errors (RER) at repeated sequences distributed throughout their genome. These RER-positive cancers had pathological characteristics of more frequent exophytic growth, large size and poor differentiation. However, the histogenesis and immunohistochemical characteristics of these RER-positive cancers are not known. The poorly differentiated colorectal carcinomas are heterogenous group of neoplasms that differ in their histologic appearance and prognosis. We therefore examined RER from 69 sporadic colorectal carcinomas of poor differentiation and detected in 23 cases (33%). The pathological features of RER-positive cancers differed from those without RER. The RER-positive cancers had marked preponderance of proximal location (16/23, 70%, vs. 20/46, 43%, p < 0.04), no glandular differentiation with intense peritumoral immune response (12/23, 52% vs. 6/46, 13%, p < 0.001). Immunohistochemically, most of the RER-positive cancers were reactive for cytokeratin (22/23, 96%) and CEA (17/23, 74%), and negative for NSE (2/23, 9%), chromogranin (3/23, 13%) and synaptophysin (0/23, 0%). In comparison to 46 RER-negative tumors, RER-positive cancer had less frequent CEA expression (17/23, 74% vs. 44/46, 96%, p = 0.01). We conclude that the RER-positive colorectal carcinomas have histologic characteristics of predominantly solid, poorly differentiated adenocarcinomas with intense peritumoral reaction and the tumors should be distinguished from neuroendocrine carcinomas and other more aggressive non-glandular tumors of the colon.
最近研究表明，几乎所有遗传性非息肉病性结直肠癌综合征（HNPCC）相关的癌症以及一部分散发性结直肠癌，在其整个基因组中分布的重复序列处都存在DNA复制错误（RER）。这些RER阳性癌症具有外生性生长更频繁、体积大且分化差的病理特征。然而，这些RER阳性癌症的组织发生学和免疫组化特征尚不清楚。低分化结直肠癌是一组异质性肿瘤，其组织学表现和预后各不相同。因此，我们检测了69例散发性低分化结直肠癌的RER，在23例（33%）中检测到RER。RER阳性癌症的病理特征与无RER的癌症不同。RER阳性癌症在近端位置占明显优势（16/23，70%，对比20/46，43%，p<0.04），无腺管分化且肿瘤周围有强烈免疫反应（12/23，52%对比6/46，13%，p<0.001）。免疫组化方面，大多数RER阳性癌症对细胞角蛋白呈反应性（22/23，96%）和癌胚抗原（CEA，17/23，74%），对神经元特异性烯醇化酶（NSE，2/23，9%）、嗜铬粒蛋白（3/23，13%）和突触素（0/23，0%）呈阴性。与46例RER阴性肿瘤相比，RER阳性癌症的CEA表达频率较低（17/23，74%对比44/46，96%，p = 0.01）。我们得出结论，RER阳性结直肠癌具有主要为实性、低分化腺癌且伴有强烈肿瘤周围反应的组织学特征，这些肿瘤应与神经内分泌癌及结肠其他侵袭性更强的非腺性肿瘤相鉴别。
