原发性肺淋巴上皮瘤样癌临床病理观察

Primary lymphoepithelioma-like carcinoma of the lung: a clinical analysis

目的探讨原发性肺淋巴上皮瘤样癌(LELC)的临床病理学特征、诊断与鉴别诊断、治疗与预后。方法对1例LELC组织行HE及免疫组化En Vision两步法染色,结合相关文献对LELC进行回顾性分析。结果患者左肺上叶肿物,镜下肿瘤组织无腺癌及鳞状细胞癌分化特征。癌细胞呈合胞体状聚集成堆,细胞核呈空泡状,核仁明显红染,其间可见不同程度淋巴细胞、浆细胞浸润及纤维性间质包绕。免疫组化:癌细胞CK强(+),CK7、CK5/6、TTF-1、CD31、CD79a、CD68、CD34、CD3、CD20、HMB45均为(-),Ki-67指数为60%,原位杂交检测EBV小RNA(EBER)为阳性。结论 LELC与EB病毒感染有关,病理组织学及免疫组化是其主要确诊方法。该病对化疗较敏感,宜采用手术为主的多方法综合治疗,预后较好。

Objective To investigate the clinicopathological features,diagnosis,differential diagnosis,treatment and prognosis of the primary lymphoepithelioma like carcinoma（ LELC） of the lung. Methods A case of LELC of the lung was observed by HE and immunohistochemistry（ En Vision） with review of the related literatures. Results The neoplasm located in upper lobe of the left lung. The tumor showed no differentiation to adenocarcinoma and squamous cell carcinoma characteristics under microscope. Histological study showed the cohesive clusters composed of syncytial-appearing cells with vesicular nuclei and clear and red nucleoli. Tumor was infiltrated with lymphocytes and plasma cells in fibrous stroma.Immunohistochemistry showed that cytokeratin was strongly positive in the case. CK7,CK5 /6,TTF-1,CD31,CD79 a,CD68,CD34,CD3,CD20 and HMB45 were negative,proliferating index labeled by Ki-67 was 60%. In situ hybridization showed positive expression of EBV-encoded small nuclear RNA（ EBER）. Conclusion LELC of the lung is associated with Epstein-Barr virus infection. Histopathological and immunohistochemical analysis is the main method of diagnosis.LELC may response to chemotherapy. Surgery-based multimodality treatment is recommended.