肺基底细胞样大细胞癌的临床病理学分析

Clinicopathologic Analysis of Lung Basaloid Large Cell Carcinoma

目的分析肺基底细胞样大细胞癌(BLCC)的临床病理学特征。方法对2012年全年病理确诊的9例BLCC患者的临床病理学资料进行回顾性分析,并通过免疫组化方法检测HCK、P63、Syn、CgA、TTF-1等指标的表达情况。结果 9例BLCC占同期肺大细胞癌(LCC)的10.8%,占同期肺癌的0.6%。其中,男性8例,女性1例;平均年龄66.8岁;肿瘤最大径平均5.3 cm;影像学多表现为中央型。术前通过痰脱落细胞学、纤维支气管镜活检和肺穿刺活检三种手段,无1例确诊。9例患者均行手术切除。术后组织病理学9例均得以确诊,其中1例BLCC合并浸润性腺癌,3例发生淋巴结转移。结论 BLCC发病率低,是一种高度侵袭性的恶性肿瘤。BLCC的临床表现无特异性,确诊依靠病理学诊断。充分掌握BLCC独特的病理形态学特点和免疫组化表达特点,可显著提高BLCC的确诊率。

Objective To analyze and summarize the clinicopathologic characteristics of lung basaloid large cell carcinoma （BLCC）. Methods Clinieopathologie data of 9 cases with BLCC eonfirmed by pathology in 2012 were retrospectively reviewed. Expression of HCK, P63, Syn, CgA, CKT, CK5/6 and TTF-1 were detected by immunohistochemisty method. Results 9 cases of BLCC accounted for 10.8% of lung large cell carcinoma （LCC） and 0.6% of lung cancer. 8 cases were male, 1 female, the average age is 66.8 years old. Average maximum diameter of the tumor was 5.3 cm. Central type was common manifestations in imageology. Sputum exfoliocytology, biopsy of bronchofibroscope and paracentesis were adopted before surgery, whereas none of BLCC were diagnosed. 9 cases underwent surgical resection. Postoperative pathology diagnosis indicated that 9 cases were BLCC, l case was combined with adenocarcinoma infiltrating. Lymph node metastasis occured in 3 cases. Conclusion Incidence rate of BLCC is low and BLCC is a highly aggressive malignancy. Clinical manifestation of BLCC do not have specificity and final diagnosis of BLCC depends on pathology diagnosis. Diagnosis rate of BLCC will be significantly improved, only if unique pathomorphology and immunohistochemical expression characteristics are thoroughly mastered.