肺肠型腺癌15例临床病理分析

Pulmonary Enteric Adenocarcinoma:A Clinicopathological Analysis of 15 Cases

目的探讨肺肠型腺癌(pulmonary enteric adenocarcinoma,PEAC)的临床病理特征、诊断、鉴别诊断及预后。方法回顾性分析15例PEAC的临床资料、病理形态、免疫表型、分子特征等,并复习相关文献。结果镜下见肿瘤细胞呈高柱状,假复层排列成腺样、筛状、乳头状或实性结构,腺腔内可见坏死物及核碎裂,类似结直肠腺癌的形态。肿瘤细胞CK7(13/15)、CDX2(12/15)、CK20(6/15)、MUC2(1/2)、TTF1(7/15)、Napsin A(4/15)及SPB(1/8)阳性。EGFR基因突变率为12.5%(1/8),为21号外显子L858R突变;未发现EML4-ALK融合基因和ROS1融合基因。随访4～57个月,3例分别于术后5、19、36个月死亡,12例生存状态良好。结论 PEAC是肺腺癌的少见变型,其组织学形态与结直肠腺癌相似,详细的临床病史、组织学的异质性及免疫表型是诊断与鉴别诊断的依据,EGFR、EML4-ALK等肺腺癌常见基因突变在PEAC中少见,预后有待长期密切的随访。

Objective To study the clinicopathological characteristics,diagnosis,differential diagnosis and prognosis of pulmonary enteric adenocarcinoma(PEAC).Methods 15 cases of PEAC were collected and the clinical data,pathological morphology,immunophenotype and molecular characteristics were analyzed,with review of the literatures.Results Histopathologically,the tumor cells were high columnar,pseudostratified into glandular,sieve,papillary or solid structure,necrosis and nuclear fragmentation in the glandular cavity,similar to colorectal adenocarcinoma.The tumor cells expressed CK7(13/15),CDX2(12/15),CK20(6/15),MUC2(1/2),TTF1(7/15),Napsin A(4/15)and SPB(1/8).The mutation rate of EGFR gene was 12.5%(1/8)and was L858R in exon 21.While gene mutations such as EML4-ALK and ROS1 were negative.Followed up for 4~57 months,3 cases died at 5,19 and 36 months after operation respectively,while 12 cases were in good condition.Conclusion PEAC is a rare variant of pulmonary adenocarcinoma,whose histological morphology is similar to colorectal adenocarcinoma.Detailed clinical history,histological heterogeneity and immunophenotype are the basis of diagnosis and differential diagnosis.EGFR,EML4-ALK and other common gene mutations in pulmonary adenocarcinoma are rare in PEAC.The prognosis of PEAC needs long-term close follow-up.