1例鼻窦SMARCA4 缺失性癌伴颅内侵袭临床病理学分析
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南京医科大学第三附属医院

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常州市卫生健康委员会重大科技项目ZD202117


Clinicopathological analysis of sinonasal SMARCA4-deficient carcinoma with intracranial invasion
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    摘要:

    [摘要]目的:探讨鼻窦 SMARCA4 缺失性癌伴颅内侵袭的临床病理特点、免疫表型及分子特征。方法:回顾性分析 1 例自鼻窦侵入颅内的 SMARCA4 缺失性癌的组织学形态、免疫表型及分子改变,分析其临床病理特征并复习相关文献。结果:患者男性,70 岁,因鼻窦肿瘤侵入颅内而进行手术。镜下,肿瘤细胞呈巢团状、实性片状分布,局灶坏死;肿瘤细胞核浆比高,核圆形至卵圆形,核分裂活跃,类似大细胞神经内分泌癌。免疫组化上,肿瘤细胞呈AE1/AE3、Syn部分阳性,BRG1 表达缺失,INI-1 未缺失,Ki-67 增殖指数 70%。下一代测序(next-generation sequencing,NGS)显示 SMARCA4 第 8 外显子 c.1252C>T(p.Q418*)无义突变,CTNNB1 第3外显子 c.134C>T(p.S45F)错义突变。泛癌生存分析显示,SMARCA4/CTNNB1 共突变组与仅 SMARCA4 突变组的预后差异有统计学意义(P<0.001)。结论:鼻窦SMARCA4 缺失性癌是一种罕见且高度侵袭性的鼻窦癌,其组织学形态缺乏特异性,SMARCA4/BRG1 抗体筛查对早期诊断至关重要,NGS 检测可为患者提供更为精准的诊断信息。

    Abstract:

    [Abstract] Objective:To explore the clinicopathological features, immunophenotype, and molecular characteristics of sinonasal SMARCA4-deficient carcinoma with intracranial invasion. Methods:Retrospective analysis of the histological features, immunophenotype, and molecular alterations in a case of SMARCA4-deficient carcinoma invading intracranially from the sinonasal region, with clinicopathological characterization and literature review. Results:A 70-year-old male patient presented with a sinonasal tumor invading intracranially. Microscopically, the tumor cells were arranged in nests and solid sheets with focal necrosis. The tumor cells exhibited a high nuclear-to-cytoplasmic ratio, round to oval nuclei, and brisk mitotic activity, resembling large cell neuroendocrine carcinoma. Immunohistochemistry showed partial positivity for AE1/AE3 and Syn, loss of BRG1 expression, retained INI-1, and a Ki-67 proliferation index of 70%. Molecular testing revealed a nonsense mutation in SMARCA4 exon 8(c. 1252C>T, p. Q418*)and a missense mutation in CTNNB1 exon 3(c. 134C>T, p. S45F). Pan-cancer survival analysis revealed that the difference in outcomes between the SMARCA4/CTNNB1 co-mutation group and the SMARCA4- only mutation group was statistically significant(P <0.001). Conclusion:Sinonasal SMARCA4-deficient carcinoma is a rare and highly aggressive sinonasal cancer with non-specific histological features. SMARCA4/BRG1 immunohistochemical screening is crucial for early diagnosis, while next-generation sequencing(NGS)can provide more precise diagnostic information for patients.

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  • 收稿日期:2025-07-12
  • 最后修改日期:2025-12-20
  • 录用日期:2026-04-13
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