肺大细胞神经内分泌癌1例报道并文献复习

Large Cell Neuroendocrine Carcinoma of the Lung (LCNEC): A Case Report and Literature Review

肺大细胞神经内分泌癌是一种罕见的低分化、侵袭性强的高级别恶性肿瘤。临床病历资料:患者为中年女性,1月前无明显诱因出现间断咳嗽,咳痰,偶伴喘息,胸部CT (临时阅片):左肺占位伴肺不张、肺炎。入院后查肿瘤系列(女性){电化学发光}发现多项指标异常;查颈部、锁骨上、锁骨下淋巴结彩超均回报无异常淋巴结。查腋下淋巴结彩超:左侧腋下低回声团块(考虑M)。患者左腋窝淋巴结考虑转移可能,行浅表淋巴结穿刺活检明确病理,“穿刺标本”病理回报:(左侧腋窝)转移性分化差的癌,坏死明显,免疫组化支持为大细胞神经内分泌癌。CK (AE1/AE3) (点状+),CK7 (点状+),NapsinA (−),TTF-1 (+),P40 (−),PD-1 (UMAB199) (−),PDL1 (22C3) (CPS:2),SYN (+),INSM1 (+),ChrA/CgA (+),Ki-67 (70%),CK5/6 (−)。根据腋窝淋巴结病理修正诊断:肺大细胞神经内分泌癌IV期(T4N × M1),补充诊断:淋巴结转移癌,家属拒绝进一步完善骨扫描、头核磁等评估全身转移情况。

Large Cell Neuroendocrine Carcinoma of the Lung is a rare, poorly differentiated, highly aggressive, high-grade malignancy. Clinical medical records: the patient was a middle-aged female, with inter-mittent cough, expectoration and occasional wheezing before 1 month, chest CT (temporary review): left lung space accompanied by atelectasis and pneumonia. After admission, tumor series (female) {electrochemiluminescence} found several abnormal indicators;the neck, supraclavicular and in-fraclavicular lymph nodes showed no abnormal lymph nodes. Check the axillary lymph node color ultrasound: left subaxillary hypoechoic mass (considering M). The possibility of metastasis was con-sidered in the left axillary lymph node, and superficial lymph node puncture biopsy was performed to clarify the pathology. The pathology of the “puncture specimen”: (left axilla) with poor metastatic differentiated carcinoma, obvious necrosis, and immunohistochemical support for large-cell neu-roendocrine carcinoma. CK (AE1/AE3) (part+), CK7 (part+), NapsinA (−), TTF-1 (+), P40 (−), PD-1 (UMAB199) (−), PDL1 (22C3) (CPS:2), SYN (+), INSM1 (+), ChrA/CgA (+), Ki-67 (70%), CK5/6 (−). According to the pathological correction of axillary lymph node diagnosis: pulmonary large cell neuroendocrine carcinoma stage IV (T4N × M1), supplementary diagnosis: lymph node metastasis cancer, the family members refused to further improve the bone scan, head nuclear magnetic field and other assessments to assess the systemic metastasis.