肺基底样鳞癌临床病理和免疫组化分析

Basaloid-squamous carcinoma of the lung:a clinicopathologic andimmunohistochemical study

目的 :根据形态学特点 ,结合免疫组织化学分析 ,了解肺基底样鳞癌的生物学行为和组织发生。方法 :在352例肺癌的研究中确诊该病的有11例(0.31 %) ,以SP法作免疫组化观察。结果 :患者年龄42至69岁(平均年龄53岁) ,男女比例为10∶1。11例临床均为中晚期肺癌 ,1例主要由基底样细胞构成、兼有灶性肉瘤成分 ,8例兼有鳞癌分化 ,1例伴有腺鳞癌分化 ,还有1例兼有腺癌分化。基底样细胞呈小叶、巢状、条索或筛状结构 ,有粉刺样坏死和周边栅栏状排列。11例均有邻近淋巴结转移 ,1例还有脑转移 ,3例有胸膜蔓延 ,1例有壁层心包膜蔓延。免疫组化见基底样细胞CK和EMA呈弱阳性或阴性 ,PCNA弥漫阳性 ,6例NSE呈阳性或灶性弱阳性 ,5例CgA呈灶性阳性或弱阳性。结论 :临床资料、组织病理和免疫表型表明 ,该肿瘤起源于支气管粘膜的未分化多能干细胞 ,具有异质性和明显侵袭性生物学行为。

Objective:To investigate the biologic behavior and histogenesis of basaloid squamous carcinoma (BSC) of the lung on basis of its morphological features and immunohistochemical analysis.Methods:By preliminary analysis among 352 cases of lung carcinoma,11 cases (0.31%) of BSC were diagnosed.Immunohistochemical studies using SP method were performed on these cases.Results:The patients' ages ranged from 42 to 69 years old(mean age,53 years old),the male/female ratio was 10/1.All 11 cases were middleor late staged lung carcinoma,and the basaloid component predominated in one of them with foci sarcoma,squamous differentiation were also presented in 8 cases,adenosquamous carcinoma differentiation in 1 case,adenocarinoma differentiation in another case.Basaloid cells formed lobules,nests,cords and cribriform patterns with comedonecrosis and peripheral palisading.Immunohistochemistry revealed weak reactive or negative for wide spectrum keratin and EMA in the basaloid cell nests,diffuse,strong immunoreactive for PCNA was demonstrated in all the tumors,6 tumors displayed focal weak reactivity for NSE and 5 for chromogranin A.Conclusion:The clinical data,histopathology and immunologic pheontype suggest that BSC is derived from the basal stem cell of bronchial mucosa and show heterogeniety and aggressive biologic behavior.