肺原发甲胎蛋白阳性肝样腺癌1例

Primary α-fetoprotein positive hepatoid adenocarcinoma of the lung:a case report

报道1例83岁男性患者,因"咳嗽伴痰中带血6个月"入院,诊断肺原发甲胎蛋白(AFP)阳性肝样腺癌。患者既往吸烟史60余年,肿瘤指标:AFP>3000 ng/ml、癌胚抗原(CEA)31.5 ng/ml、糖类抗原(CA)72446.90 U/ml、角蛋白21-110.20 ng/ml、NSE 18.50 ng/ml,经皮肺穿刺病理提示:低分化癌伴显著坏死,结合免疫组化及临床实验室检查结果考虑为转移性肝细胞癌可能。PET-CT提示右下肺、部分胸膜及纵隔多发淋巴结FDG代谢升高,肝脏及其他系统及组织未见FDG代谢异常,遂诊断肺原发AFP阳性肝样腺癌,分期为T4N3M1aⅣA期。通过该例患者资料及基于现有文献开展复习,了解相关临床和病理特点、诊断方法、治疗和预后,提高临床诊断和治疗水平。

This paper reports the data of a patient who was admitted to hospital for"cough with blood in sputum for 6 months"and diagnosed withα-fetoprotein(AFP)positive primary hepatoid adenocarcinoma of the lung.The patient was an 83-year-old male with a history of smoking for more than 60 years.Tumor indicators of patients were:AFP>3000 ng/ml,carcinoembryonic antigen(CEA)31.5 ng/ml,CA72446.90 U/ml,Cyfra21-110.20 ng/ml,NSE 18.50 ng/ml,and the pathological findings of percutaneous lung biopsy showed that poorly differentiated cancer with significant necrosis.Combined with the results of immunohistochemistry and clinical laboratory examination,it is considered as metastatic hepatocellular carcinoma.PET-CT showed that FDG metabolism of multiple lymph nodes in the right lower lung,part of the pleura and mediastinum was increased,and the FDG metabolism in the liver or other systems/tissues was normal.Based on these results,it was diagnosed as AFP positive primary hepatoid adenocarcinoma of the lung,and the tumor stage was T4N3M1a(IVA).Through the data of the patient and the existing literature and reviews,we can get the tumor characteristics,diagnosis,treatment and prognosis of HAL,and improve the level of diagnosis and treatment of HAL by clinicians.