肺原發性淋巴上皮瘤樣癌的臨床病理分析

Clinicopathologic analysis of primary lymphoepithelioma-like carcinoma of the lung

目的分析原發性肺淋巴上皮瘤樣癌(Lymphoepithelioma-like Carcinoma,LELC)的臨床病理特點。方法分析6例原發性肺淋巴上皮瘤樣癌的臨床病理資料。結果6例原發性肺淋巴上皮瘤樣癌患者中,男2例,女4例,均為中国澳門居民;均無吸煙,中位數年齡57.5歲。組織學特徵為成片分佈的合體細胞樣生長,有大的泡狀核,核仁明顯,伴有明顯淋巴細胞浸潤。6例患者的免疫組化染色:6例P63均為陽性,5例CK5/6陽性,1例CK5/6灶性陽性;原位雜交檢測EBV小RNA(EBER)6例均為陽性,1例TTF-1局灶陽性,其餘均陰性,6例CK7均陰性。1例死亡病例發現時已多處轉移且只口服化療藥半個月就自行放棄治療,其餘5例手術及化療等治療後至今生存。結論LELC是一種特殊類型的肺癌,與EB病毒感染有關,中位數年齡57.5歲,經病理組織學及免疫組織化學檢查診斷,對化療敏感,宜手術為主的綜合治療,預後較肺大細胞癌好。

Objective To analyze the clinicopathologic features of primary Lymphoepithelioma-like Carcinoma(LELC)of the Lung.Methods To analyze the clinicalpathological data of 6 cases of primary LELC of the lung.Results Of the 6 LELC patients,2 were males and 4 females;all were Macao residents and non-smokers;median age=57.5 years.Histological features of LELC cells included a characteristic sheets and syncytial pattern of growth,large vesicular nuclei with prominent nucleoli,and marked lymphocytic infiltrate.Immunohistochemical staining of 6 patients revealed 6 cases positive for P63,five cases positive for CK5/6,one case of CK5/6 focally positive;In situ hybridization showed positive expression of EBV-encoded small nuclear RNA(EBER)in all of the 6 cases,with one case positive for TTF-1 focally,and the rest of them were negative.Six cases were negative for CK7.One dead case has been found to have multiple metastases and gave up her oral chemotherapy in two weeks.The remaining 5 patients have survived after surgery and chemotherapy.Conclusion LELC is a special type of lung cancer associated with EB virus infection,with a median age of diagnosis at 57.5 years.Diagnosis was by histopathology and immunohistochemistry.It is responsive to chemotherapy,and surgery-based multimodality treatment is recommended.The prognosis is better in patients with LELC than in patients with large cell carcinoma of lung.