具有透明细胞形态的肺肿瘤60例临床病理分析

Clinical and pathological analysis of 60 cases of lung tumors with clear cell morphology

目的探讨具有透明细胞形态的肺肿瘤的临床病理特征及鉴别诊断方法。方法选择60例具有透明细胞形态的肺肿瘤,对其临床资料、病理形态特点及免疫组化表达情况进行分析。结果 27例具有透明细胞形态的肺腺癌CK7、TTF-1、Napsin A阳性,15例肺透明细胞性鳞状细胞癌CK5/6、p63、p40阳性,两者免疫组化表达的差异具有显著性(P<0.001)。6例肺透明细胞癌(肺大细胞癌亚型)肿瘤组织分化差,异型性明显,核分裂像多见,且不具有明确的肺腺癌及肺鳞状细胞癌分化特征。9例转移性透明细胞性肾细胞癌与3例肺透明细胞瘤(肺"糖瘤")病理形态相似,均为大量透明细胞及丰富的薄壁血管,但前者巢状结构比较清晰,间质内含较多纤细的薄壁血管,常见淋巴细胞浸润,免疫组化Vim、CK-L阳性,而肺透明细胞瘤的薄壁血管穿插在肿瘤细胞间,有时可形成鹿角样结构,免疫组化HMB45、S-100阳性,PAS染色阳性。结论具有透明细胞形态的肺肿瘤的病理诊断及鉴别诊断需结合病理形态、免疫组化及特殊染色综合判断。

Objective To explore the clinicopathological characteristics and differential diagnosis of lung tumors with clear cell morpholo-gy. Methods The data of clinicopathological features and immunohistochemistry of 60 lung tumors with clear cell morphology were reviewed. Re-sults Twenty - seven cases of lung adenocarcinoma with clear cell morphology：immunohistochemical staining：positive for CK7,TTF - 1,Napsin A,compared to 15 cases of clear cell lung squamous cell：positive for CK5 / 6,p40,p63,showed a significant difference（ P 〈 0. 001）. 6 cases of lung clear cell cancer（a subtype of large cell lung cancer）：it poorly differentiated,atypia was remarkable and mitoic was common,and had no clear differentiation features of lung adenocarcinoma and squamous cell carcinoma. 9 cases of metastatic clear cell renal cell carcinoma were similar to 3 cases of lung clear cell tumor（＂sugar＂ tumor）with clear cell and thin - walled vessels. The former was arranged in a prominent nesting pat-tern separated by thin - walled vessels,lymphocytes were easy to see,and positive for Vim,CK - L. The latter：thin - walled blood vessels inter-spersed between tumor cells,antler - like structure can be formed sometimes and positive for HMB45,S - 100 and PAS. Conclusion The diag-nosis of lung tumors with clear cell morphology depends on comprehensive analysis of clinical data,histopathology and immunohistochemistry.