83例肺大细胞癌的临床病理学分析

Clinicopathologic analysis of 83 cases with large cell lung carcinoma

分析总结肺大细胞癌(large cell 1ung carcinoma,LCLC)的临床病理学特征及治疗方案。方法:对2012年1月至2012年12月天津医科大学附属肿瘤医院病理确诊的83例LCLC患者的临床病理学资料及治疗方案进行回顾性分析。结果:83例LCLC占同期肺癌的5.4%(83/1 551)。男性63例,女性20例;平均年龄60.4岁;肿瘤最大径平均4.6 cm;影像学多表现为周围型。术前通过痰脱落细胞学、纤维支气管镜活检和肺穿刺活检3种手段,只有4例4.8%(4/83)明确诊断或考虑为LCLC。63例76%(63/83)患者行手术切除,以肺叶切除术为主。术后病理学诊断包括39例经典型LCLC、31例大细胞神经内分泌癌、2例复合性大细胞神经内分泌癌、8例基底细胞样癌、2例透明细胞癌和1例淋巴上皮瘤样癌。LCLC各亚型具有独特的病理形态学特点和免疫组织化学表达特点。有75%(62/83)LCLC发生淋巴结转移。结论:LCLC发病率低,是一种高度侵袭性的恶性肿瘤。LCLC的临床表现和影像学特点无特异性,确诊依靠病理学诊断。LCLC治疗以手术为主,提高LCLC的确诊率和进一步细分病理亚型对规范LCLC的综合治疗具有重要的指导作用。

Objective： This study aimed to analyze and summarize the clinicopathologic characteristics and treatment protocols of large cell lung carcinoma （LCLC）. Methods： Clinicopathologic data of 83 cases with LCLC confirmed by pathology in 2012 were retrospectively reviewed. Results： Exactly 83 cases of LCLC accounted for 5.4% of ltmg cancer in 2012. Sixty-three cases were male and twenty were female. The average age was 60.4 years old. The average maximum diameter of the tumor was 4.6 cm. The common manifestations in imageology were peripheral type. Only four cases were correctly diagnosed by sputum exfoliocytology, biopsy of bronchofibroscope, and paracentesis before surgery. Sixty-three cases （76%） underwent surgical resection, and pulmonary lobectomy was mainty selected. Postoperative pathology diagnosis indicated that 39 cases were classic large cell carcinoma, 31 were large cell neuroendocrine carcinoma, 2 were combined large cell neuroendocrine carcinoma, 8 were basaloid carcinoma, 2 were clear cell carcinoma, and 1 was lymphoepithelioma-like carcinoma. Each subtype of LCLC had respective characteristics of pathomorphology and immunohistochemistry. Lymph node metastasis occurred in 62 cases （75%）. Conclusion： The incidence rate of LCLC, which is a highly aggressive malignancy, is low. The clinical manifestation and imageology characteristics of LCLC do not have specificity, and its final diagnosis depends on pathology diagnosis. Operation is the main treatment method. Improving the diagnosis rate of LCLC and further subdividing the pathological subtypes are important for a normalized comprehensive treatment of LCLC.