肺原发性肝样腺癌临床病理特征及文献复习

Primary hepatoid adenocarcinoma of the lung:clinicopathological characteristics and literature review

目的探索肺原发性肝样腺癌(Hepatoid adenocarcinoma,HAC)的临床病理特征、免疫组织化学表型、鉴别诊断及预后。方法应用HE染色及免疫组织化学染色法观察并分析我院病理科诊断的一例肺原发性HAC患者的临床病理特点及免疫组织化学表型,并总结相关文献。结果患者男性,74岁,体检发现右上肺占位10天来我院就诊,CT示右肺上叶占位,合并纵隔淋巴结肿大。送检肿物大小5cm×4.5cm×3cm,切面灰白,镜下肿瘤细胞呈实性状、巢状,细胞核大、深染,胞质嗜酸性,细胞核易见小核仁及病理性核分裂象,可见血窦样间质,类似肝细胞癌。免疫组织化学染色显示AFP、Sall4、Glypican 3、CK(Pan)、CK7阳性,CK5/6、TTF-1、napsin A、vimentin、CD56、Syn、CgA阴性,Ki67的增值指数高表达,约为80%。PAS染色阳性。结论肺原发性HAC是一种较罕见及特殊类型的腺癌,临床病理特征独特,易发生转移及静脉侵犯,治疗以手术切除为主,辅助以放化疗,因临床进展相对较快,预后相对较差,临床医生及病理医师需高度重视。

Objective To explore the clinicopathological characteristics,immunohistochemical phenotype,differential diagnosis and prognosis of primary lung hepatoid adenocarcinoma(HAC).Methods HE staining and immunohistochemical staining were used to observe and analyze the clinicopathological characteristics and immunohistochemical phenotypes of a patient with primary pulmonary HAC,and we summarized the relevant literatures.Results The patient was a 74-year-old male who came to hospital 10 days after being diagnosed with a space-occupying lesion in the right upper lung by physical examination.CT scan showed that the right upper lung was occupied,with mediastinal lymphadenopathy.The size of the tumor is 5 cm × 4.5cm × 3 cm,the cut surface is gray,the tumor cells are solid and nested under the microscope,the nucleus is large and deep stained,the cytoplasm is eosinophilic,and small nucleoli and pathological mitoses are easy to be observed in the nucleus.Sinusoid stroma is visible,similar to that in hepatocellular carcinoma.Immunohistochemistry showed AFP,Sall4,Glypican3,CK(Pan),and CK7 were positive,while the CK5/6,TTF-1,NapsinA,Vimentin,CD56,Syn,CgA were negative,and Ki67 value-added index was high(about 80%).PAS staining was positive.Conclusion Primary pulmonary HAC is a rare and special type of adenocarcinoma with unique clinicopathological characteristics,prone to metastasis and venous invasion.The treatment is mainly surgical resection,assisted by radiotherapy and chemotherapy.Due to its rapid clinical progression,the prognosis is relatively poor,so clinicians and pathologists need to attach great importance.