肺透明细胞类癌1例报告及文献复习

目的探讨肺透明细胞类癌的临床病理特征、诊断与鉴别诊断要点、治疗及预后。方法对来自本院胸外科的1例肺透明细胞类癌青年男性患者的手术标本切片,进行组织形态学观察和免疫组织化学检测,并结合文献进行临床病理分析。结果患者因体检发现右下肺包块2年入院,切除标本见肿瘤位于右下肺边缘,为一边界清楚、质地中等的灰白色类圆形结节。镜下观察见均匀一致的肿瘤细胞呈片状或巢团状排列,细胞体积较大,细胞质透明,核圆居中。免疫组化显示肿瘤细胞CD56、Syn、CgA均为强阳性,CK、TTF-1阳性,Ki-67阳性细胞数<1%,S-100蛋白灶性阳性,Vimentin间质血管阳性,而HMB45、SMA、GFAP、Actin均为阴性。病理诊断:肺透明细胞类癌。行肺叶切除术后至今(6年)未见复发转移。结论肺透明细胞类癌是一种非常罕见的低度恶性肿瘤,仔细的大体检查、广泛取材和正确的免疫组化标记是诊断的关键;准确的病理组织学分型对治疗和预后评估有重要意义。

Pulmonary clear cell carcinoid tumor: a case report and review of the literature

Objective To report a case of pulmonary clear cell carcinoid tumor,and to discuss its clinical and pathological features,key points of diagnosis,treatment and prognosis.Methods The pathological and immunohistochemical data of a young male patient with pulmonary clear cell carcinoid tumor admitted in Southwest Hospital was collect,and the literature was reviewed.Results The gross of tumor showed a medium-size and round ashen tubercle with a clear boundary.The microscopy observation showed uniform large tumor cells with transparent cytoplasm and round nuclei in the center,and the tumor cells showed a dispersed or nested arrangement.The immunohistochemical staining showed that CgA,Syn and CD56 were strongly positive and CK and TTF-1 were positive in tumor cells,but SMA,HMB45,GFAP and actin were all negative.The number of Ki-67-positive cells was less than 1%.S-100 protein was focally positive,and vimentin was positive in interstitial blood vessels.No recurrence or metastasis was observed for 6 years after the surgical resection of the pulmonary tumor.Conclusion Pulmonary clear cell carcinoid tumor is a rare form of low malignant potential tumors.Careful gross examination,wide-range sampling and correct immunohistochemical staining are critical for appropriate diagnosis,and both of the treatment and prognosis evaluation are dependent on the histopathological types of carcinoid carcinoma.