1 武汉大学人民医院病理科，武汉 430060
为探讨原发性直肠鳞状细胞癌(squamous cell carcinoma，SCC)的临床病理特征、诊断、治疗及预后，收集1例原发性直肠SCC的临床病理资料，观察其组织病理学特征及免疫表型，并复习相关文献。患者男，40岁。无明显诱因出现大便带血入院，肠镜示“直肠隆起性病变性质待查”，行放疗及化疗后手术切除病变肠段，大体肉眼可见3 cm ×3 cm ×3 cm隆起质硬区，切面灰白，质硬。镜下组织学表现可见大量巢团状肿瘤细胞，呈浸润性生长，浸润至肠壁外脂肪组织。肿瘤细胞呈中- 低分化，部分细胞圆形、卵圆形，胞质丰富、淡染，单个细胞内可见角化，部分细胞分化较差， 呈梭形，染色质粗，细胞异形性明显伴大量病理性核分裂，可见少量淋巴细胞浸润。免疫组织化学结果显示CK5/6，P16，P63，P40，CAM5.2均阳性，Ki-67 LI约50%。直肠原发鳞状细胞癌罕见， 预后差，其特征性的组织形态、免疫组织化学表型有助于诊断和鉴别诊断，治疗上尚无公认的最佳方案，需从发病机制及诊治等方面进行更深入的研究。
Primary rectal squamous cell carcinoma: A clinicopathological observation and literature review
This work was supported by the Science and Technology Planning Project of Wuhan, China (2017060201010172).
To investigate the clinicopathological features, diagnosis, treatment and prognosis of primary rectal squamous cell carcinoma (SCC), a case of primary rectal SCC was collected, Histopathological features and immunophenotype were observed. The related literatures were reviewed. A male patient, 40 years old, stool with blood without obvious reason. Enteroscopy showed “protuberant rectal lesions, nature to be investigated”. After radiotherapy and chemotherapy, the diseased intestinal segment was resected surgically. In general, 3 cm ×3 cm ×3 cm uplift hard area was visible to the naked eye. The section was gray and hard. Microscopically, a large number of nest-like tumor cells infiltrated into the parenteral adipose tissue. The tumor cells were moderately to poorly differentiated, some of them were round and oval, with abundant and pale cytoplasm, keratinization was seen in single cells, and some of them were poorly differentiated, spindle-shaped, with thick chromatin. The cell heteromorphism was obviously accompanied by a large number of pathological mitosis and a small amount of lymphocyte infiltration. Immunohistochemistry showed that the tumor cells were positive for CK5/6, P16, P63, P40, CAM5.2, Ki-67 LI was about 50%. Primary rectal SCC is rare and has a poor prognosis. Its characteristic histomorphology and immunohistochemical phenotype are helpful to the diagnosis and differential diagnosis. There is no accepted best treatment for this disease. Further studies should be made from the aspects of pathogenesis, diagnosis and treatment.
rectal squamous cell carcinoma; pathological characteristics; immunohistochemistry