肺原发性肠型腺癌和肺转移性结直肠腺癌的临床病理差异性分析

Comparative analysis of clinicopathological features between primary pulmonary enteric adenocarcinoma and metastasis colorectal cancer

目的探讨肺原发性肠型腺癌和肺转移性结直肠腺癌的临床病理学差异,为肺原发性肠型腺癌的鉴别诊断和分子靶向治疗提供参考依据。方法收集2016年1月至2021年12月大连医科大学附属第一医院病理学诊断为肺原发性肠型腺癌6例和肺转移性结直肠腺癌16例患者的临床病理资料和组织学样本。应用免疫组织化学、荧光原位杂交和实时定量PCR技术,探讨二者分子病理特征差异。结果相对于肺转移性结直肠腺癌,肺原发性肠型腺癌肿瘤较大(P=0.044),病理分期较早(P<0.001),胸膜侵袭较为常见(P=0.025)。肺原发性肠型腺癌均出现CK7和Villin免疫组化阳性表达,Ki-67和P53阳性表达率低于肺转移性结直肠腺癌(P<0.05)。肺原发性肠型腺癌和肺转移性结直肠腺癌KRAS基因突变率相当(P>0.05)。肺原发性肠型腺癌3例出现HER2蛋白的阳性表达中1例有HER2基因扩增,1例存在HER2基因突变。结论免疫组化CK7和Villin的阳性表达,在肺原发性肠型腺癌和肺转移性结直肠腺癌的鉴别诊断中有较高的应用价值。肺原发性肠型腺癌出现HER2基因扩增和突变阳性可能具有一定诊断治疗价值。

Objective We analyzed the differences of clinicopathological features between primary pulmonary enteric adenocarcinoma(PEAC)and metastasis colorectal cancer(MCC),in order to help differential diagnosis from metastasis colorectal cancer and look for new treatment target for primary pulmonary enteric adenocarcinoma.Methods A retrospective study was performed on 6 PEACs and 16 MCCs,which were diagnosed in the First Affilliated Hospital of Dalian Medical University from January 2016 to December 2021.Immunohistochemistry,real-time PCR and fluorescence in situ hybridization were used to detect protein expression,gene mutation and amplification.Results Compared with MCCs,PEAC had larger lesions(P=0.044)with a more early pathological stage(P<0.001)and more frequent pleural invasion(P=0.025).Different from MCCs,CK7 and Villin were both positive and lower frequency of Ki-67 and P53 positive expression in PEACs(P<0.05).Half of PEACs were positive for HER2,including HER2 amplification in one case and HER2 mutation in another case.Conclusion The current study suggested that CK7 and Villin double positivity in PAEDs would be beneficial markers of differential diagnosis from metastasis colorectal cancer.HER2 amplification and mutation in PEACs could have potential clinical significance.