肺原发性绒毛膜癌1例报道及文献复习

目的 探讨肺原发性绒毛膜癌临床病理特征、诊断标准、治疗及临床转归。方法 分析1例肺原发性绒毛膜癌的临床表现、组织病理学及免疫表型特征，并进行文献复习。结果 患者，男性，53岁。临床表现咳嗽、咳血痰。影像学检查示右肺下叶肿块，全身他处未见异常。病理学检查发现肿物几乎均可见出血、坏死，其中有少数肿瘤细胞呈簇团状或小片状分布。瘤组织由中等大小、胞质透明的细胞（细胞滋养层细胞）和大而异型、胞质丰富、粉染或空泡状的多核巨细胞（合体滋养层细胞）构成。免疫表型显示瘤细胞，特别是多核巨细胞表达CK（AE1／AE3）、CK7、HCG、PLAP、Ki-67及p53，但不表达CEA、TTF1、CK20、AFP等。术后联合化疗，无瘤生存12个月，仍在随访中。结论 肺原发性绒毛膜癌是一种罕见的高度侵袭性肿瘤，具有其独特的临床病理特征，手术联合化疗是最有效的治疗方案。

Primary choriocarcinoma of lung: a case report and review of literature

Purpose To investigate the clinicopathological characteristics, diagnostic criteria, most appropriate management and outcome of primary choriocarcinoma of the lung.Methods The clinical presentations, histopathological features and immunophenotype were studied in one case of primary choriocarcinoma of the lung, and related literature was reviewed.Results A 53-year-old man complained of cough and bloody sputum. A mass of the right lower lung was found by image. Then examination was given carefully and completely to exclude the underlying lesions of other part of the body. Microscopically, the tumor showed extensive necrosis and hemorrhage. Microscopically, the tumor was characteristics of choriocarcinoma, with large multinucleated cells representing syncytiotrophoblast admixed with medium-sized cells, often with clear cytoplasm, similar to cytotrophoblasts. Immunohistochemically, the tumor cells were reactive for CK(AE1/AE3), CK7, HCG, PLAP, Ki-67 and p53, but not for CEA, TTF1, CK20 and AFP. Patients treated with both surgery and chemotherapy and disease-free survived for 12 months and still under follow-up now.Conclusions PCC of the lung is a rarity with the most progressive behavior and variable clinical characteristics. Analysis of the literature indicates that resection followed by adjuvant chemotherapy is the most effective treatment.