肺假血管肉瘤样癌1例报道及文献复习

Pseudoangiosarcomatous Carcinoma of the Lung: A Case Report and Review of Literature

目的 探讨肺假血管肉瘤样癌的诊断和鉴别诊断。方法 应用常规组织病理、免疫组化观察 1例肺假血管肉瘤样癌并复习相关文献。结果 肿瘤大体检查有典型的肺鳞状细胞癌的形态 ,界限清楚 ,中央有坏死。镜下见肿瘤细胞排列成分支吻合状、乳头状、血窦状的血管样腔隙 ,衬以明显异型的上皮样细胞 ,腔内红细胞呈“血液湖”状 ,肿瘤细胞周围有明显的慢性炎症细胞反应。局部仅见细胞间桥样结构 ,未见角化珠。肿瘤细胞表达EMA、keratin、CEA和vimentin ,而SMA ,CD31,CD34,UEA Ⅰ ,Ⅷ因子均阴性。结论 肺假血管肉瘤样癌是罕见的肺肉瘤样癌亚型 。

Objective To explore the diagnosis and differential diagnosis of pseudoangiosarcomatous carcinoma (PASC) of the lung. Methods A case of PASC in the lung was studied with conventional histopathological and immunohistochemical stains. Results The gross appearance of the tumor was typical squamous cell carcinoma of the lung. Microscopically, the tumor shown the presence of interanatomosing, papillary and sinuous blood vessel like spaces lined by overtly atypical epitheloid cells. Erythrocytes in pseudoluminal spaces looked like 'blood lakes'. The tumor incited a remarkable chronic inflammatory response. Cohesive cellular growth pattern was focally apparent and epithelial pearls were not found. The tumor cells showed positive staining for EMA, keratin, CEA and vimentin, but negative for desmin, CD31, Factor VIII, CD34, UEA 1, HBME 1 and SMA. Conclusion PASC is an extremely rare variant of sarcomatoid carcinoma of the lung, which differs pathogenetically from primary pulmonary angiosarcoma.