原发性肺印戒细胞腺癌临床病理分析

Clinicopathological Analysis of Primary Signet Ring Cell Adenocarcinoma of the Lung

目的探讨原发性肺印戒细胞腺癌(PSRCACL)的临床病理学特点、诊断与鉴别诊断及其预后因素等。方法收集2000年1月-2012年6月间50例PSRCACL患者的临床资料,进行组织学及免疫组织化学检测观察,并进行随访和结合文献复习分析。结果 PSRCACL的临床症状及影像学表现与非小细胞肺癌无明显差异,其诊断与鉴别诊断依据其特殊的细胞形态学及免疫组织化学检测。PSRCACL的发病率约占肺腺癌的1.20%,平均发病年龄为53.3岁,中位年龄为54.5岁,男女比例为1.17︰1。患者的中位生存时间约为56个月,1年生存率约为85.4%,3年生存率约为67.4%,5年生存率约为40.9%。患者的生存率与患者的性别、年龄无关(P>0.05),与肿瘤的大小、是否伴有癌转移及TNM分期有关(P<0.05)。结论 PSRCACL是一种比较罕见的、好发于中青年人、恶性程度较高、易发生侵袭和转移、预后较差的恶性上皮性肿瘤,除手术治疗外,目前尚无标准化疗方案。

Objective To investigate the clinicopathological features, the diagnosis and differential diagnosis, prognostic factors of primary signet ring cell adenocarcinoma of the lung （PSRCACL） which is a rare malignant epithelial tumor. Methods We reviewed the clinical data of 50 patients with PSRCACL treated between January 2000 and June 2012. Light microscopy and immunohistochemistry were used for observation of these cases, and follow-up and relative literatures were also analyzed. Results There was no significant difference between PSRCACL and non-small cell lung cancer in clinical symptoms and imaging findings, and the diagnosis and differential diagnosis relied on their special morphology of cells and immunohistochemistry. The incidence of PSRCACL accounted for about 1.20% of lung adenocarcinoma. The patients＇ average age was 53.3 years old, with a median age of 54.5 years. The male to female ratio of these cases was 1.17： 1. The median survival time was about 56 months. One-year survival rate was about 85.4%, 3-year survival rate was about 67.4%, and 5-year survival rate was about 40.9%. The survival rates of the patients were correlated with cancer metastasis, TNM staging and tumor size （P 〈 0.05）, but were not correlated with their age and gender （P 〉 0.05）. Conclusions Primary signet ring cell adenocarcinoma of the lung is a rare and highly aggressive malignancy. Most patients are relatively young. Invasion and migration frequently occur. The prognosis is poor. In addition to surgery, there is no standard chemotherapy.