文章摘要

10例肺多形性癌的临床及病理分析

作者: 1李 苁, 1李 霞, 1梁 加贝, 1路 旭东, 1杨 树东
1 南京医科大学附属无锡人民医院病理科,江苏 无锡 214023
通讯: 杨 树东 Email: ysd-zh@163.com
DOI: 10.3978/j.issn.2095-6959.2019.09.005

摘要

目的:探讨肺多形性癌的临床病理特点,鉴别诊断,影像学特点及预后。方法:回顾性分析无锡市人民医院胸外科2012年3月至2018年4月收治的10例肺多形性癌患者的临床及病理资料。采用组织病理学及免疫组化标记进行回顾性分析。结果:10例患者均为男性,发病年龄为59~71岁;8例有既往大量吸烟史,2例无烟酒嗜好;7例首发症状为咳嗽咳痰,3例伴痰中带血。患者肿瘤长直径2.8~9.5(平均6.2) cm;7例发生于右肺,3例发生于左肺。肺多形性癌中含恶性上皮成分和多形性成分。恶性上皮成分包括9例腺癌,1例鳞癌;多形性成分包括恶性梭形细胞和/或巨细胞成分。肿瘤细胞不同程度表达AE1/AE3,CK7,TTF-1,Napsina,CK5/6,Vimentin等,增殖指数Ki-67为40%~80%。4例患者淋巴结见转移,9例患者获得随访,1例失访,目前最长生存时间为41个月,仍存活,最短生存时间为术后7个月。结论:肺多形性癌是少见的高度恶性肿瘤,好发于中老年吸烟男性;大部分肺多形性癌可通过组织病理与免疫组化鉴别诊断,目前外科手术为首选治疗方法,预后差。
关键词: 肺肿瘤;多形性癌;病理

Clinicopathological analysis of 10 cases of pulmonary pleomorphic carcinoma

Authors: 1LI Cong, 1LI Xia, 1LIANG Jiabei, 1LU Xudong, 1YANG Shudong
1 Department of Pathology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Jiangsu 214023, China

CorrespondingAuthor:YANG Shudong Email: ysd-zh@163.com

Abstract

Objective: To discussed the clinical and histopathologic features, differential diagnosis, imaging features and prognosis of pulmonary pleomorphic carcinoma (PPC). Methods: Histopathology and immunohistochemistry were used for the retrospective analysis of 10 patients with PPC, who underwent surgical resections in Wuxi People’s Hospital from March 2012 to April 2018. Results: All patients were male, with varying ages from 59 to 71 years. Eight patients had previous heavy smoking history, and the remaining two did not smoke or drink. Seven patients occurred with initial symptoms including cough or expectoration, and three of them were with haemoptysis. In this group, the average diameter of the tumor was 6.2 cm, and the maximum and minimum tumor diameter were 9.5 cm and 2.8 cm, respectively. Among these ten patients, seven had PPC in the right lung and three had PPC in the left lung. Malignant epithelial components and polymorphic components were found in these patients. Specifically, malignant epithelial components include 9 cases of adenocarcinoma and 1 case of squamous cell carcinoma, and polymorphic components include malignant spindle cells and/or giant cell components. Epithelial components differentially expressed CK, AE1/AE3, CK7, TTF-1, Napsina, TTF-1, CK5/6, Vimentin and so on, with varied value-added Ki-67 index (40%–80%). Additionally, four patients occurred with lymph node metastasis. After the surgery, nine patients obtained postoperative follow-up with the shortest survival period of 7 months after surgery. The longest survivor is still alive at the 41th month after the surgery. Conclusion: PPC is a rare and highly malignant tumor, which occurs mostly in middle-aged smoking male. Most PPC can be differentially diagnosed by histopathology and immunohistochemistry. Currently, surgery is a preferred treatment for PPC, but prognosis of PPC is poor.
Keywords: lung neoplasma; pleomorphic carcinoma; pathology