肺原发性肝样腺癌临床病理学分析及文献复习

Primary hepatoid adenocarcinoma of the lung:a clinicopathological analysis and review of literature

目的探讨肺原发性肝样腺癌的临床病理特点及临床预后,并复习相关文献。方法收集自贡第四人民医院2009—2021年肺原发性肝样腺癌病例2例,对其临床资料、病理形态、免疫组织化学标记进行综合分析,总结相关临床病理资料及鉴别诊断,并复习相关文献。结果肺原发性肝样腺癌,镜下:癌细胞可呈条索样、髓样、梁状、实性团巢块状等排列,癌细胞较大,胞质丰富红染,嗜酸性,胞质透明样,核仁明显,可见病理性核分裂象,细胞异型较大,肿瘤细胞间有丰富的血窦,具有肝细胞癌样和腺癌分化的特征。免疫组化示肿瘤细胞Hepatocyte、Glypican-3、CK8/18、CK7阳性;而CK5/6、TTF-1、CEA、Vimentin、TTF1、CD56、CgA、Syn、NapsinA、P63、P40、CD31、CD68、SALL4阴性。结论肝样腺癌是起源上皮来源,属于具有高侵袭力的高度恶性肿瘤,病理特点与肝细胞癌相似性、诊断此病首先排除肝细胞肝癌转移,或者其他脏器的肝样腺癌转移,治疗方案主要是根治术手术治疗、放化疗、靶向治疗、免疫治疗等,总体预后比较差。

Objective To investigate the clinicopathological features and clinical prognosis of primary hepatoid adenocarcinoma of the lung,and to review the relevant literature.Methods Two cases of primary hepatoid adenocarcinoma of the lung in Zigong Fourth People’s Hospital from 2009 to 2020 were collected.Their clinical data,pathological morphology and immunohistochemical markers were comprehensively analyzed,the relevant clinicopathological data and differential diagnosis were summarized,and the relevant literature was reviewed.Results Under the microscope,the cancer cells were arranged in strip,medullary,frabecular,and solid nest patterns.The cancer cells were large,with abundant,red stained,or eosinophilic cytoplasm,and sometimes the cytoplasm was transparent;the nucleolus was obvious,and pathological mitosis was noted with cell atypia.There were abundant blood sinusoids between the tumor cells,which had the characteristics of hepatocellular carcinoma-like and adenocarcinoma differentiation.Immunohistochemistry showed that tumor cells were positive for hepatecyte,Glypican-3,CK8/18 and CK7;CK5/6,TTF-1,CEA,vimentin,CEA,TTF1,CD56,CGA,syn,napsina,p63,P40,CD31,CD68 and Sall4 were negative.Conclusion Hepatoid adenocarcinoma is a highly invasive and highly malignant tumor with epithelial origin.Its pathological characteristics are similar to hepatocellular carcinoma.The diagnosis of this disease first excludes the metastasis of hepatocellular carcinoma or hepatoid adenocarcinoma in other organs.The treatment schemes are mainly radical surgery,radiotherapy and chemotherapy,targeted therapy and immunotherapy.The overall prognosis is relatively poor.