随着最近对女性生殖道（尤其是子宫颈）中胃型病变的阐明，已经报道了偶尔出现子宫内膜腺癌表现出胃（胃肠道）分化的病例，但是目前尚不认为它们是独特的病理学实体。我们报告9例子宫内膜粘液性病变，通过形态和免疫组织化学表现出胃（胃肠道）型特征，包括4例腺癌和5例良性粘液性病变，年龄在32至85岁之间。腺癌在所有4例病例中均表现出胃型形态。杯状细胞1例，有良性胃型黏液腺1例。免疫组织化学分析，腺癌的CK7（4/4），CEA（4/4），MUC6（3/3），PAX8（3/4），CK20（2/4），CDX2（2/4）和雌激素受体（1/4）。他们的Napsin A（0/3）阴性，突变型p53染色为2/4例，斑驳性p16阳性为1/4，散发的嗜铬粒蛋白阳性细胞为1/2。有针对性的下一代测序表明，对于p16阳性的病例，RB1基因无意义的突变。在所有腺癌病例中都可以进行随访，并显示出侵袭行为。2例患者在7个月至3个月的随访中死亡，1例在9个月时存活，而1例在7个月时没有疾病存活。良性粘液性病变（包括1例腺癌的良性成分）在5/6例中表现出胃型形态特征，在5/6例中表现出杯状细胞，在1/6例中表现出Paneth样神经内分泌细胞。这些良性粘液性病变伴有子宫内膜息肉5/6例。细胞学上的非典型性表现为2/6例，小叶结构类似于子宫颈小叶内膜腺体增生，为4/6。免疫组织化学检查，良性粘液性病变的CK7（5/5），CDX2（5/6），雌激素受体（4/5），MUC6（4/5），CK20（3/5），PAX8（3/5）呈阳性）和CEA（2/4），其中散在的嗜铬粒蛋白阳性细胞为4/4；在所有测试的情况下，NapsinA均为阴性，p53为野生型，p16为阴性。对于这种独特的罕见侵袭性子宫内膜癌，我们提出了术语“子宫内膜胃（胃肠道）型腺癌”。我们认为，良性或非典型胃（胃肠道）型粘液性病变是这些腺癌的假定前体，可与子宫颈和阴道中公认的恶性胃前性病变相媲美。
FIGURE 1. Histologic features of endometrial adenocarcinomas exhibiting gastric (gastrointestinal)-type differentiation. The adenocarcinomas exhibit a confluent glandular and papillary architecture (A, B). Case exhibiting myometrial invasion (C). Gastrictype morphologic features with pale eosinophilic to clear cytoplasm with distinct cell borders are present (D, E). Case exhibitingmyometrial invasion and necrosis (F).
FIGURE 2. Histologic and immunohistochemical features of gastric-type adenocarcinoma with component of benign mucinousglands in case 1. Neoplastic glands exhibiting enlarged hyperchromatic nuclei coexist with benign mucinous glands whichresemble gastric pyloric glands (A, B). Immunohistochemistry shows MUC6 positivity in both malignant and benign elements (C).The adenocarcinoma (left) shows diffuse mutation-type positivity for p53 while the benign glands (right) show a wild-type pattern(D). ER is completely negative in the adenocarcinoma (left) but focally positive in the benign mucinous glands (right) (E); similarlyPAX8 is focally weakly positive in the adenocarcinoma (left) but diffusely positive in the benign mucinous glands (right) (F).
FIGURE 3. Histologic features of benign gastric (gastrointestinal)-type mucinous lesions of the endometrium. Mucinous glandsand atrophic endometrial glands are present (A). Goblet cells (B) and pale eosinophilic cytoplasm typical of gastric-type mucinouslesions (C) are commonly found. Focal nuclear enlargement and hyperchromasia qualifying as cytologic atypia may be present (D).Mild glandular crowding (E) and lobular architecture resembling cervical LEGH (F) are present in some cases.
FIGURE 4. Immunohistochemical findings in endometrial gastric-type adenocarcinomas. In case 2, the adenocarcinoma showsdiffuse positive staining for MUC6 (A), as well as block-type positivity for p16 (B) and wild-type expression of p53 (C). Focalexpression of the enteric markers CDX2 (D) and CK20 (E) is observed in case 1, which also features scattered chromograninpositive cells (F).
FIGURE 5. Immunohistochemical findings in benign gastric (gastrointestinal)-type mucinous lesion of the endometrium (case 5).The mucinous glands are focally positive for MUC6 (A), with goblet cells highlighted by CK20 (arrows) (B), while ER is focallypositive (C) and PAX8 is diffusely positive (D). Scattered chromogranin-positive cells are present (arrowheads) (E), as well as focalCDX2 positivity (F).
Endometrial Gastric (Gastrointestinal)-type Mucinous Lesions: Report of a Series Illustrating the Spectrum of Benign and Malignant Lesions.Wong RW, Ralte A, Grondin K, Talia KL, McCluggage WG.Am J Surg Pathol. 2020 Mar;44(3):406-419.
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