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目的 探讨伴发直肠腺癌的肛周佩吉特病 (Paget′sdisease)的临床病理学特征、组织学发生及特点。方法 对 3例伴发直肠腺癌的肛周佩吉特病进行临床病理学分析 ,作过碘酸雪夫(PAS)、阿辛蓝和黏液卡红染色 ,采用免疫组织化学EnVision法行癌胚抗原 (CEA)、CK7、CK8、CK10 / 13、CK2 0和巨囊性病液体蛋白 15(GCDFP 15)标记。结果 3例均发生于中老年男性 ,因便血和 (或 )大便习惯改变就诊。肛指检查显示距肛 1 8～ 2 0cm处可触及溃疡型或菜花状肿块 ,3例中 2例肛周皮肤伴有湿疹样改变 ,1例呈细颗粒状。术后标本显示直肠肿瘤位于齿状线上方或紧邻齿状线 ,组织学上为中分化腺癌 (2例 )或低分化腺癌 (1例 )。肛周皮肤内佩吉特细胞主要有两种形态 ,一种为经典型 (A型 ) ,另一种为印戒型 (B型 ) ,两种类型细胞可存在于同一病例中。直肠腺癌细胞和皮肤佩吉特细胞PAS、AB和黏液卡红染色均为强阳性 ,PAS和AB染色耐淀粉酶消化 ,并同时表达癌胚抗原、CK7、CK8和CK2 0标记 ,而CK10 / 13和GCDFP 15标记均为阴性。结论 免疫表型为CK2 0 + GCDFP15- 的肛周皮肤佩吉特细胞由结直肠腺癌细胞扩散到表皮内所致。此型肛周皮肤佩吉特病伴结直肠腺癌的概率可高达 60 % ,较发生于其他部位的乳腺外佩吉特病高 ,提示一旦发现肛?
Objective To investigate the clinicopathological features, histological features and histopathological features of Paget’s disease in perianal patients with rectal adenocarcinoma. Methods Three cases of Paget’s disease with perianal rectal adenocarcinoma were analyzed by clinicopathological analysis. Peri-salvate (PAS), Alcian blue and mucardin staining were performed. Envelope immunohistochemistry (EnVision) was used to detect carcinoembryonic antigen (CEA) ), CK7, CK8, CK10 / 13, CK20 and GCDFP15. Results All the 3 cases occurred in middle-aged and old men, and the patients were changed due to blood stool and / or bowel habits. The anus examination showed that the ulcer or cauliflower-like mass was accessible at a distance of 18-20 cm from the anus. Two cases of perianal skin accompanied by eczema-like changes in 3 cases showed fine granular form. The postoperative specimens showed that the rectal tumor was located above or adjacent to the dentate line, with histologically moderately differentiated adenocarcinoma (2 cases) or poorly differentiated adenocarcinoma (1 case). There are two main forms of Paget’s cells in the perianal skin. One is classic (type A) and the other is signet ring type (type B). Two types of cells may exist in the same case. Rectal adenocarcinoma cells and skin Paget cells were strongly positive for PAS, AB and mucardin staining. PAS and AB staining were resistant to amylase digestion and expressed carcinoembryonic antigen, CK7, CK8 and CK20 while CK10 / 13 and GCDFP 15 were negative. CONCLUSION: Peri-peritum Paget’s cells with immunophenotype CK2 0 + GCDFP15- are diffused into the epidermis by colorectal adenocarcinoma cells. This type of perianal skin Paget’s disease with colorectal adenocarcinoma probability up to 60%, occurred in other parts of the extra-Breast extra-Paget disease, suggesting that once found anal?