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目的探讨阑尾原发性印戒细胞癌的临床病理特征及鉴别诊断,并进行文献复习,旨在提高对阑尾原发性印戒细胞癌的认识。方法回顾性分析1例术后病理明确诊断为阑尾原发性印戒细胞癌患者的临床资料、病理组织学形态及免疫组化标记物,并结合相关文献进行复习。结果患者男性,70岁。因间断右下腹痛3月余入院。B超示右中下腹可见4.3 cm×1.6 cm大小盲管状低回声,不可压瘪,未见明显蠕动,提示右中下腹异常回声为肿胀阑尾可能。术中见阑尾尖端膨大、充血水肿,与周围黏连;纵形剖开阑尾见尖端阑尾壁增厚,腔内可见黏液样物。镜下见阑尾尖端黏膜层至深肌层大量肿瘤细胞浸润,单个、条索状或3~5个肿瘤细胞呈簇状弥漫分布,无特殊排列结构,无腺管状结构;肿瘤细胞呈圆形、卵圆形或多角形,胞质丰富淡染,嗜碱性,可见细小空泡或大的黏液空泡,胞核形状不规则、深染,位于胞质一侧,似印戒样。免疫组化示肿瘤细胞CDX2、CK20和CEA(+),E-cad、CD56、Cg A、Syn和NSE(-)。本例手术后1个月行右半结肠切除术,术后病理未见肿瘤细胞,未行化疗,随访至今未复发。结论阑尾原发性印戒细胞癌是一种阑尾罕见的恶性肿瘤,临床上多以急慢性阑尾炎就诊。依据其特有的病理组织学形态及免疫组化表现,与其他原发性及转移性肿瘤鉴别,可明确诊断。
Objective To investigate the clinicopathological characteristics and differential diagnosis of primary signet ring cell carcinoma of the appendix and to review the literature in order to improve the understanding of primary signet ring cell carcinoma of the appendix. Methods The clinical data, histopathological features and immunohistochemical markers of 1 patient diagnosed as primary signet ring cell carcinoma of the appendix were retrospectively analyzed, and the related literatures were reviewed. Results The patient was male, 70 years old. Right lower abdominal pain due to intermittent more than 3 months admitted to hospital. B ultrasound shows the right lower abdomen can be seen 4.3 cm × 1.6 cm blind tube-shaped hypoechoic, incompressible, no significant peristalsis, suggesting that the right lower quadrant anomalous echo may be swollen appendix. See the appendectomy tip surgery, congestion and edema, and the surrounding adhesions; longitudinal incision appendix see the tip of the appendix wall thickening, mucus visible cavity. Microscope to see the apical mucosa to the deep myometrial a large number of tumor cell infiltration, single, cord-like or 3 to 5 tumor cells were clustered diffuse distribution, no special arrangement, no glandular tubular structure; tumor cells were round, Oval or polygonal, rich in cytoplasm lightly stained, basophilic, showing small vacuoles or large vacuolar vacuoles, irregular nuclear shape, stained, located on the side of the cytoplasm, like a ring. Immunohistochemistry showed that the tumor cells CDX2, CK20 and CEA (+), E-cad, CD56, Cg A, Syn and NSE (-). This case a month after surgery right half colon resection, no pathological postoperative tumor cells, no chemotherapy, follow-up has not relapsed. Conclusions The primary signet ring cell carcinoma of the appendix is a rare malignant tumor of the appendix. Most patients are treated with acute and chronic appendicitis. According to its unique histopathological and immunohistochemical findings, and other primary and metastatic tumors to identify, can confirm the diagnosis.