伴神经内分泌分化的小肠转移性肺巨细胞癌临床病理观察

Clinical and pathological analysis of lung giant cell carcinoma with neuroendocrine differentiation metastatic to small intestine

目的探讨伴神经内分泌分化的小肠转移性肺巨细胞癌的临床病理特点。方法采用光镜、电镜及免疫组化等方法，观察1例伴神经内分泌分化的小肠转移性肺巨细胞癌患者的临床与病理学资料，并复习相关文献。结果患者空肠肠壁有3处瘤结节，瘤细胞呈肉瘤样疏松排列，弥漫浸润肠壁全层，局部累及肠黏膜上皮。瘤细胞体积巨大，形态不规则，多见巨核与多核瘤巨细胞，间质多量中性粒细胞浸润。免疫组化标记显示瘤细胞CK-L、CK7、Vimenfin、NSE、CgA和TIF-1（＋），而CK20和villin（-）。电镜观察瘤细胞具有上皮特征和神经内分泌颗粒。依据光镜电镜的形态观察与免疫组化检测，再结合以往病史，确诊为伴神经内分泌分化的小肠转移性肺巨细胞癌。结论肺癌肠转移很少见，但当肺癌患者术后出现消化道症状或腹部占位病变时，要首先考虑到肺癌肠转移的可能，尤其肺巨细胞癌更易发生消化道转移。伴有神经内分泌分化的肺巨细胞癌发生小肠转移者预后不良。

Objective To study the clinicopathologic features and signifieances of small bowel metastasis of lung giant cell carcinoma with neuroedocrine differentiation. Methods The clinical and pathological data in a case of multiple small bowel metastases of lung giant cell carcinoma with neuroedocrine differentiation were observed and analyzed by light microscopy, electron microscopy and immunohistechemical staining. Results There were three separated tumors in the jejunum. Microscopically, all tumors showed same histological pattern and consisted almost exclusively of poorly cohesive, polymorphic giant cells, some of which were muhinueleated. Diffuse and mild infiltration with neutrophilie cells were seen in all tumors. Tumors infiltrated the whole intestinal wall and focal mucosa was affected. Immtmohistochemically, tumor cells were positive for cytokemtin-low, CK7, vimentin, TTF-1, NSE and CgA, while negative for CK20 and vii/in. Electmn-miemseopieal/y, there were cell connections on the surface and neurosecretory granules in the cytoplasm of the tumor cells. The pathologic diagnosis of the left upper lobe tumor was lung giant cell carcinoma instead of poorly differentiated squamous cell carcinoma. According to the histopathological structure, labeling results and the clinical history, we made the diagnosis： jejunal metastasis of lung giant cell carcinoma with neuroedocrine differentiation. Conclusion Metastases from lung cancer to gastrointestinal tract are rare; when lung cancer patients have abdominal symptoms, metastases from bronchial and pulmonary carcinoma to the small bowels should be first considered. The histologic type of metastatic tumors to jejunum most commonly is giant cell carcinoma or large cell carcinoma.