消化系统SWI/SNF复合物缺失性癌31例临床病理学分析
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南京医科大学第一附属医院

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南京医科大学第一附属医院青年基金培育计划(编号:PY2023058)


Clinicopathological analysis of 31 cases of SWI/SNF complex deficient carcinoma in digestive system
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the First Affiliated Hospital with Nanjing Medical University

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    摘要:

    目的:探讨消化系统酵母交配型转换/蔗糖不发酵(switch/sucrose non-fermentable complex,SWI/SNF)染色质重塑复合物缺失性癌的临床病理学特征、免疫表型、分子遗传学改变特点,并分析其诊断及鉴别诊断要点。 方法:收集31例消化系统SWI/SNF复合物缺失性癌患者的临床资料,观察其组织学形态,总结免疫组织化学结果和分子改变特点,并复习相关文献进行分析。 结果:31例患者中,男性19例,女性12例,年龄43-80岁,平均年龄64岁,中位年龄66岁。发病部位情况:食管下段(胃食管交界处)1例,胃7例,右半结肠3例,胰腺18例,肝胰壶腹部2例。病灶最大径1.5cm-18cm(中位数3.5cm)。组织学上,15例肿瘤呈未分化癌形态,表现为瘤细胞多呈弥漫、实性片状排列,也可巢状、条索状或假腺样结构,多数病例可见凝固性坏死区域。肿瘤细胞以黏附性差的上皮样细胞为主,胞浆丰富淡染或嗜酸性,细胞核染色质稍粗糙或呈空泡状,可见明显的核仁,病理性核分裂象易见。部分病例可见横纹肌样肿瘤细胞。16例为低到中分化导管腺癌、腺鳞癌或导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)伴相关浸润性癌。免疫表型上,14例未分化癌显示BRG1失表达,1例胰腺未分化癌出现INI1部分缺失性表达,而BRG1保留表达。4/15例肿瘤细胞CK-pan表达阴性或仅散在表达,其他上皮性标记仅见个别肿瘤细胞阳性或多为阴性。7/13例Syn部分肿瘤细胞弱到中等阳性,其中2例分别见散在的CD56或INSM1弱阳性,CgA全部为阴性。16例胰腺/壶腹部癌BRG1保留表达;8/16例INI1部分失表达或表达减弱,另外8/16例保留表达。随访22例患者,6例患者死亡。分子病理:14/16例胰腺癌或壶腹癌出现了SMARCB1基因突变,2/16例出现SMARCA4基因突变,所有病例均可见KRAS基因突变,14/16例中出现TP53基因突变。 结论:消化系统SWI/SNF复合物缺失性癌是一种少见的高度恶性肿瘤,部分为未分化癌没有特定的分化特征,胃肠道外SWI/SNF缺失性癌可能更多出现不同分化程度的腺癌形态,认识并了解其组织学和免疫组化表达特点可提示行BRG1和INI1等SWI/SNF蛋白检测以减少漏诊和误诊;胰腺癌中SWI/SNF相关基因突变与KRAS和TP53基因突变具有相关性。

    Abstract:

    Objective: To investigate the clinicopathological features, immunophenotype and molecular genetic changes of switch/sucrose non-fermentable complex (SWI/SNF) complex deficient tumors in digestive system, and to analyze the diagnosis and differential diagnosis points. Methods: The clinical data of 31 patients with SWI/SNF complex deficient carcinoma of digestive system were collected. The histological morphology, immunohistochemical results and molecular changes were observed and analyzed. Results: Among the 31 patients, 19 were male and 12 were female, aged 43-80 years, mean age 64 years, median age 66 years. Location of disease: lower esophagus (gastroesophageal junction) 1 case, stomach 7 cases, right colon 3 cases, pancreas 18 cases, ampulla 2 cases. Histologically, 15 tumors were undifferentiated carcinoma, showing diffuse, solid, or nested, streaked, or pseudoglandular pattern of tumor cells, coagulative necrotic areas were seen in most cases. The tumor cells were mainly epithelioid cells with poor adhesion, rich cytoplasm, light staining or eosinophilic, slightly rough or vacuolar nuclear chromatin, obvious nucleoli, pathological mitotic figures were easy to see.16 cases were poorly to moderately differentiated ductal adenocarcinoma, adenosquamous carcinoma or intraductal papillary mucinous tumor (IPMN) with associated invasive carcinoma. Immunophenotype: 14/15 cases of undifferentiated carcinoma showed BRG1 loss expression, 1 case of undifferentiated carcinoma in pancreas showed INI1 partial loss expression, but BRG1 retained expression. CK-pan expression was negative or scattered in 4/15 cases of tumor cells, other epithelial markers were occasional positive or mostly negative in some tumor cells. 7/13 Syn tumor cells were weakly to moderately positive, 2 of them were weakly positive for CD56 or INSM1, and all of them were negative for CgA. BRG1 expression was retained in 16 pancreatic/ampullary carcinomas, INI1 expression was partially lost or decreased in 8 of 16 pancreatic/ampullary carcinomas, and retained in 8 of 16 pancreatic/ampullary carcinomas.22 patients were followed up, 6 patients died. Molecular pathology: SMARCB1 gene mutation was found in 14/16 cases of pancreatic or ampullary cancer, SMARCA4 gene mutation was found in 2/16 cases, KRAS gene mutation was found in all cases, and TP53 gene mutation was found in 14/16 cases. conclusion: SWI/SNF complex deficient tumor is a rare and highly malignant tumor, some of them are undifferentiated carcinomas without specific differentiation features. Extragastrointestinal SWI/SNF complex deficient carcinoma may have more differentiated adenocarcinoma morphology. Understanding its histological and immunohistochemical expression characteristics may suggest the detection of SWI/SNF proteins such as BRG1 and INI1 to reduce missed diagnosis and misdiagnosis. SWI/SNF-related gene mutations were associated with KRAS and TP53 gene mutations in pancreatic cancer.

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  • 收稿日期:2025-09-28
  • 最后修改日期:2025-10-28
  • 录用日期:2025-11-27
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