摘要
目的 从组织学上确定胃癌淋巴结微转移灶并观察其间质反应。方法 17份胃癌标本 (10 87枚淋巴结 )中曾诊断为有微转移灶 (微灶 )的 71枚淋巴结 ,连续切片 6 0张以上行免疫组织化学SABC法染色 (CK18,上皮膜抗原 ,平滑肌肌动蛋白 ) ,观察微灶和非微灶的周围间质反应。另取 2 0枚有明显转移的淋巴结作对照观察。结果 71枚属微灶的淋巴结经再次连续切片后微灶消失的占34% (2 4枚 ) ,仍属微灶但癌细胞数增多的占 49% (35枚 ) ,转移灶扩大已不属于微灶者的占 17% (12枚 )。微灶有两种形态即小团状和单个散在分布状 ,前者有 5 0 .0 %后者有 10 .5 %出现间质反应 ;有明显转移不属微灶的淋巴结其癌灶周围并非均有间质反应 ,同一淋巴结中也并非均有间质反应。结论 (1)微灶的确定仅用少数切片 (6张或三平面 6张HE染色 + 1～ 2张免疫组织化学染色 )不能判断 ,切片数不足有 17%可能将淋巴结转移误诊为微转移而低估pN分期 ;(2 )
Objective To define lymph node micrometastasis and to investigate the difference between micrometastasis and microinvolvement. Methods A total of 1 087 regional lymph nodes were collected from surgical specimens of 17 patients with gastric carcinoma. 71 nodes were found to contain microlesions, ≤0.5 mm or ≤50 tumor cells per node by serial sections (>60 sections per node) and immunohistochemistical staining for CK18, EMA and SAM. Another 20 nodes containing macrometastasis were also studied. Results After serial sections, the microlesions disappeared in 34% (24 nodes), increased in 49% (35 nodes), microlesions transformed into macrometastasis in 17% (12 nodes). Microlesions presented as a cluster of tumor cells (≤0.5 mm) or scattered single cells (≤50 cells). Stromal reactions surrounding the clustered tumor cells were found in 50.0% of nodes while stromal reactions surrounding scattered cells were found in 10.5% of nodes. There was no consistent stromal reaction either in nodes with micrometastasis or nodes with macrometastasis, not even within a same node. Stromal reaction was more often found in the higher differentiated group. Conclusion (1) A few sections per node cannot define the nodal micrometastasis and nodal macrometastasis may be misjudged as micrometastasis without serial sections, leading to undestaging of pN. (2) The use of stromal reaction to differentiate nodal micrometastasis from nodal microinvolvement, as suggested by Siewert, is not substantiated.
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2000年第5期339-342,共4页
Chinese Journal of Pathology
基金
武汉市医学科学研究发展基金资助项目! (1996 191 2 0 )
关键词
胃肿瘤
淋巴结微转移
免疫组织化学
间质反应
Stomach neoplasms
Lymph nodes
Lymphatic metastasis
Immunohistochemistry
