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| 直肠原发性腺鳞癌1例 |
| One Case of Primary Adenosquamous Carcinoma of the Rectum |
| 投稿时间：2026-08-12 修订日期：2026-09-14 |
| DOI： |
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| 中文关键词: 直肠肿瘤 腺鳞癌 罕见肿瘤 免疫组织化学 病理诊断 预后 |
| 英文关键词:rectal neoplasms adenosquamous carcinoma rare neoplasms immunohistochemistry pathological diagnosis prognosis |
| 基金项目: |
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| 摘要点击次数: 39 |
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| 中文摘要: |
| 目的 探讨直肠原发性腺鳞癌的临床病理特征、诊断与鉴别诊断要点、治疗方案及预后特点,提高临床及病理医师对该病的认知水平与诊断准确率,减少临床漏诊、误诊。方法 回顾性分析1例直肠原发性腺鳞癌患者的完整临床资料、影像学表现、病理组织学形态及免疫组化表型,结合国内外相关文献进行系统复习与总结。结果 患者男性,69岁,因反复便血、排便习惯改变伴下腹部坠胀不适6月余入院。直肠指检及结肠镜检查提示,距肛缘2cm-8cm处可见不规则隆起,表面溃烂,覆脓苔,累及全周,管腔稍狭窄。患者完善术前准备后,行腹腔镜下直肠癌根治术(Miles术),术后病理检查示肿瘤组织内同时含有腺癌及鳞癌两种恶性成分,两种成分占比均超过10%,符合腺鳞癌诊断标准；免疫组化结果显示,腺癌成分CK20、CDX2、Villin呈阳性表达,鳞癌成分P40、P63、CK5/6呈阳性表达,Ki-67增殖指数约65%,提示肿瘤增殖活性较高。术后患者行卡培他滨单药口服治疗,规律随访6个月,患者未见局部复发及远处转移,一般状况良好。结论 直肠腺鳞癌是临床罕见的高侵袭性结直肠癌亚型,临床表现无特异性,术前诊断难度大、极易误诊,最终确诊依赖术后病理组织学检查联合免疫组化标记；临床治疗以根治性手术切除为核心,术后辅以放化疗可有效改善患者预后,整体预后较普通直肠腺癌更差。 |
| 英文摘要: |
| Objective To investigate the clinicopathological features, key points for diagnosis and differential diagnosis, therapeutic regimens and prognostic characteristics of primary adenosquamous carcinoma of the rectum, so as to raise the awareness and diagnostic accuracy of clinicians and pathologists for this disease, and reduce clinical missed diagnosis and misdiagnosis. Methods The complete clinical data, imaging findings, histopathological morphology and immunohistochemical phenotypes of one patient with primary rectal adenosquamous carcinoma were retrospectively analyzed. Relevant domestic and foreign literature was systematically reviewed and summarized. Results A 69-year-old male patient was admitted to hospital with recurrent hematochezia, altered bowel habits and lower abdominal distending discomfort for more than 6 months. Digital rectal examination and colonoscopy revealed an irregular elevated lesion 2–8 cm from the anal verge, with ulcerated surface covered by purulent exudate, circumferential involvement and mild luminal stenosis. After preoperative preparation, the patient underwent laparoscopic radical resection of rectal cancer (Miles operation). Postoperative pathological examination demonstrated that the tumor contained both adenocarcinoma and squamous cell carcinoma components, each accounting for more than 10% of the lesion, consistent with the diagnostic criteria for adenosquamous carcinoma. Immunohistochemically, the adenocarcinoma component showed positive expression of CK20, CDX2 and Villin, whereas the squamous cell carcinoma component was positive for P40, P63 and CK5/6. The Ki-67 proliferation index was approximately 65%, indicating high tumor proliferative activity. The patient received oral capecitabine monotherapy after surgery. Regular follow-up for 6 months showed no local recurrence or distant metastasis, and the patient maintained good general condition. Conclusion Primary rectal adenosquamous carcinoma is a rare, highly aggressive subtype of colorectal cancer. It presents non-specific clinical manifestations and is difficult to diagnose preoperatively, prone to misdiagnosis. Definitive diagnosis relies on postoperative histopathological examination combined with immunohistochemical markers. Radical surgical resection serves as the mainstay of clinical treatment, and postoperative adjuvant chemoradiotherapy can effectively improve patient prognosis. Its overall prognosis is poorer than that of conventional rectal adenocarcinoma. |
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