肺多形性癌的临床病理和免疫组化研究

Pleomorphic carcinoma of the lung: A clinicopathological and immunohistochemical study of 33 cases

目的多形性癌(pleomorphic carcinoma,PC)是非小细胞肺癌中相对少见的一种类型,其形态和细胞成分复杂多样,在病理诊断和鉴别诊断上存在一定难度。文中旨在探讨肺PC的临床病理、免疫组化特征及鉴别诊断要点。方法回顾性复习33例肺PC患者的临床病理资料,免疫组化染色采用EnVision法,使用的一抗包括CKpan、CK7、CK5/6、34βE12、CK8/18、P63、TTF-1、napsin A、vimentin、desmin、SMA,对所有患者进行了随访。结果 29例患者出现症状,其中咳嗽、咯血最为常见。21例患者有吸烟史(平均956支/年),其中19例为重度吸烟者。本组患者的肿瘤最常发生于肺右上叶和左上叶,瘤体直径1.2～15.0 cm(平均5.8 cm)。24例肺PC中含恶性上皮成分和多形性成分,即恶性梭形细胞和(或)巨细胞成分,9例仅含多形性成分,恶性上皮成分包括19例腺癌、3例鳞癌和2例混合性腺癌大细胞癌。33例肺PC的恶性上皮成分均表达Ckpan,不表达vimentin;多形性成分均表达vimentin,23例CKpan阳性表达,20例CK8/18阳性表达,CK7、TTF-1、P63、34βE12、naspin A、CK5/6均有不同程度阳性表达。8例患者清扫淋巴结中见转移,转移灶以恶性上皮样成分为主。25例获得随访,总生存期1～74个月,中位生存期6个月,1年生存率为44.4%,5年生存率为10%。结论肺PC多发于老年男性,肺上叶好发,可能与吸烟相关。大部分肺PC通过光镜即可诊断,免疫组化染色有助于其诊断和鉴别诊断。

Objective Pleomorphic carcinoma （PC） is a rare subtype d non-small cell lung cancer that presents a complex morphology and cellular component, challenging pathologists in its diagnosis and differential diagnosis. This study was to explore the din- ical and histopathologic features, immunophenotypes and differential diagnosis of lung PC. Methods The clinicopathologic data of 33 eases of lung PC were retrospectively analyzed. A panel of antibodies including CKpan, CK7, CK5/6, 34~E12, CK8/18, P63, ]3T-l, napsin A, vimentin, desmin, and SMA were used for EnVision immunohistochemical staining. All the cases were followed up. Results Cough and hemoptysis, as the most common symptoms, occurred in 29 cases, and 21 of the patients were current- or ex-smokers （mean 956 cigarettes per year）, including 19 heavy smokers. Most of the tumors were located in the right and left superior, sized from 1.2 cm to 15.0 cm （ mean 5.8 cm） in diameter. Microscopically, neoplastic epithelial cells and pleomorphic components, i.e. neoplasitc spindle cells and/or giant cells, were found in PC in 24 cases, and pleomorphic components only in the other 9. An adenocarcinoma component was observed in 19 cases, a squamous cell carcinoma component in 3, and a mixed adenocarcinoma and large cell carcinoma component in 2. Immunohistochecally, all neoplastic epithelial components showed diffuse and strongly positive staining for CKpan, and negative for vimentin, while the pleomorphic components in all the cases showed diffuse and strongly positive staining for vimentin, 23 for CKpan, and 20 for CK8/18. CKT, T1T-1, P63, 3413E12, naspin A and CK.5/6 were also expressed in some of the cases. Regional lymph node metas- tasis were found in 8 cases, with malignant epithelial cells as the predominant metastatic components. Follow-up data were available in 25 cases, based on which the overall survival time was 1 to 74 months （median 6 months）, and the rates of 1- and 5-year survival were 44.4% and 10%, respectively. Conclusion Pleomorphic carcino- ma of the lung usually occurs in older nudes, often seen in the upper lobes, and maybe associated with smoking. Most cases can be diagnosed by light microscopy ＇alone, and immunohistochemical staining can aid to its diagnosis and differential diagnosis.