肺原发性精原细胞瘤临床病理观察

Primary seminoma of the lung: a clinicopathological observation

目的探讨肺原发性精原细胞瘤的临床病理特征。方法对1例手术切除的肺精原细胞瘤进行临床、组织学及免疫组化观察。结果患者男性,76岁。临床表现为呼吸道症状,影像学检查提示肺癌。组织学显示瘤细胞大小基本一致,圆形或多角形,有明显胞界,胞质丰富透亮,核大深染,位于中央,圆形或椭圆形,核分裂象多见;瘤细胞呈巢状分布,间质有纤维组织增生,内可见淋巴细胞弥漫或灶状分布于癌巢间(主要为T淋巴细胞),并可见出血、坏死。免疫组化:CK、CK-LMW、CD20、HCG、Syn、CgA、HMB45和MelanA(-),CD45RO和CD3(),Vim和NSE(+),EMA局灶性弱(+),AFP和S-100极少数细胞、CD117少数细胞(+),PLAP()。结论精原细胞瘤有生殖腺内和生殖腺外之分,且它们的病理学表现类似。生殖腺外包括中枢神经系统、纵隔和腹膜后。

Objective To investigate the clinicopathologic characteristics of the primary seminoma in lung. Methods The clinical data, histopathologie changes and immunohistochemical findings were investigated in 1 case of pulmonary seminoma Results The age of the patient was 76 years old. The clinical manifestation displayed symptoms of respiratory tract involvement, and image analysis suggested lung carcinoma. Histologically the tumor cells were uniform, round or polygonal, with abundant clear cytoplasm, sharply outlined cell membranes; cytoplasm was abundant, a large centrally located nucleus was round and oval with clumped ehromatin; the tumor cells were arranged in nests, with desmoplastie stromal reaction and some lymphoid cells infiltrating diffusely or around the tumoral nests （the large majority of T-cell type）, and some areas with hemorrhage and necrosis. Immunohistochemically the tumor cells displayed positive for vimentin, EMA, CD45RO, CD3, AFP, S-100, NSE, CD117 and PLAP, but negative for CK, CK-LMW, CD20, Syn, CgA, HMβ 45, Melan A and HCG. Conclusion The seminoma can be classified as intragonadal and extragonadal types and their pathological changes are similar. The later has been found in the central nervous system, mediastinum and retroperitoneum.