胸腔混合性腺-神经内分泌癌3例病理学观察

Pathologic features of mixed glandular and neuroendocrine carcinoma of thoracic cavity

目的探讨发生在胸腔的混合性腺-神经内分泌癌的组织学特征和免疫表型。方法对3例发生在胸腔的混合性腺-神经内分泌癌的组织形态、组织化学染色、免疫组化染色及电镜进行观察,结合临床资料分析。结果癌组织由两种不同细胞成分构成,一种构成腺样、筛状结构,癌细胞呈柱状或印戒样,核染色质深;另一种构成实性巢团状、菊形团样结构,癌细胞呈小的卵圆形,胞质少,淡红染,核染色质细,肿瘤间质内血窦丰富。3例肿瘤细胞Syn和CK8/18(+),1例CgA(+),另1例CEA和CD56(+);但TTF-1均(-)。电镜下部分瘤细胞有少量神经分泌颗粒。结论胸腔混合性腺-神经内分泌癌是一种在组织形态和免疫表型上具有外分泌和内分泌肿瘤双重特点的肿瘤,诊断依靠组织学特征、免疫组化标记及电镜检查。肿瘤的生物学行为尚不确定。

Objective To investigate the histological and immunohistochemical phenotype of mixed glandular and neuroendocrine carcinoma of thoracic cavity.Methods The clinical,pathologic,histochemical,immunohistochemical and ultrastructural features were investigated in 3 cases of thoracic mixed glandular and neuroendocrine carcinoma.Results The tumor consisted of two components： one was characterized by the adenoid and cribriform structure and columnar or signet-ring tumor cells with trachychromatic nuclei;other component showed a solid and rosette-like structure with small,ovoid tumor cells which had thin cytoplasm and dust-like chromatin.Tumor cells expressed Syn,CK8/18 in both two cases,one case expressed CgA while the other expressed CEA and CD56.Neither case expressed TTF-1.Under electron microscope,there were different numbers of neurosecretory granules in a part of tumor cells.Conclusions Thoracic mixed glandular and neuroendocrine carcinoma exhibits both endocrine and exocrine features morphologically and immunohistochemically.The diagnosis depends on the histological and immunohistochemical phenotype.And electron microscopy could help the diagnosis.The biological behavior of the tumor has been not clear yet.