肺原发性肝样腺癌临床病理观察

目的探讨肺原发性肝样腺癌的临床病理特征、免疫表型、诊断和鉴别诊断。方法对2014年1月收集的1例肺原发性肝样腺癌的临床表现、大体及组织学形态、免疫组化等进行观察研究,并复习相关文献。结果患者为64岁吸烟男性,因咳嗽、咯血8 d入院。肿物大体呈卵圆形,切面灰白,境界清楚;镜下具有肝细胞癌样和腺癌分化特征,间质可见丰富的血窦。免疫组化示肿瘤细胞Hepatocyte、AFP、CK8/18、CK19、CK(pan)阳性;而CK7、CK14、CK5/6、TTF-1、CEA、Vimentin等阴性。结论肺肝样腺癌是原发于肺的上皮性恶性肿瘤,诊断的确立主要依赖发现相似于肝细胞癌的形态(肝样结构),并通过临床病理与免疫组化检测除外肝细胞癌等疾病的转移。

Ciinicopathologic characteristics of primary hepatoid adenocarcinoma of the lung

Objective To explore the clinicopathologic characteristics, immunophenotype, diagnosis and differential diagnosis of primary hepatoid adenocarcinoma of the lung. Methods A case of primary hepatoid adenocarcinoma of the lung was studied with clinical manifestations, histology and immunohistochemical staining, and its clinical and pathological findings were further analyzed with review of the literature. Results The patient was 64-years-old man with smoking history, presented with cough and hemoptysis for 8 days. Macroscopically,the ovoid tumor was well-circumscribed with a pale cut surface. Microscopically, it was composed of hepatoid area and adenocarcinomatous area,the tumor stroma was few and sinusoidal vascularity could be found. The immunohistochemistry showed that AFP, Hepatocyte, CK8/18, CK19 and CK（pan） were positive, and others markers including CK7, CK14, CK5/6, TTF-1, CEA, and Vimentin were negative. Conclusions Hepatoid adenocareinoma of the lung is a rare malignant tumor. The diagnosis of primary hepatoid adenocarcinoma of the lung is based on the finding of specific morphological features resembling hepatocellular carcinoma（bepatoid area）, and the metastasis of hepatocellular carcinoma must be excluded clinically and pathologically before making the final diagnosis.