男性肺原发性绒毛膜癌3例临床病理学特点

目的 探讨肺原发性绒毛膜癌的发病因素、诊断、鉴别诊断及分子病理学特点.方法 对3例男性肺原发性绒毛膜癌分别进行光镜观察和免疫组化检测,并分析国内、外报道病例的发病因素和临床病理学特点.结果 1例镜下瘤细胞呈多样化,一部分呈巢状排列,核深染,异型性大,部分区域瘤细胞之间可见间桥;一部分瘤细胞呈腺腔样排列,异型明显,核染色质浓;另见一小部分瘤细胞有两种:一种细胞界限清楚,多核,胞质丰富,为合体滋养叶细胞;一种细胞界限清楚,体积小,胞质透亮,为细胞滋养叶细胞.病理诊断为肺原发性绒毛膜癌合并腺鳞癌.2例镜下表现如前一例小部分瘤细胞形态.免疫组化显示瘤细胞HCG、CK和EMA( );vimentin、NSE、S-100、CEA和Syn(-).结论 发生于男性的肺原发性绒毛膜癌极其罕见,诊断时应多取组织,并详细询问病史以排除转移性癌;组织学上应与肺巨细胞癌相鉴别.

Features of clinical and molecular pathology in primary choriocarcinoma of lung

Objective To study the pathogenetic factors, diagnosis, differential diagnosis and features of molecular pathology in the primary choriocarcinoma of lung. Methods Three cases of primary choriocarcinoma of lung in males were examined by histopathology and immunohistochemistry. The pathogenetic factors, clinicopathological and molecular pathological features of the reported cases from English literatures were analyzed. Results The lesion from the first case was composed of a variety of tumor cells. Some tumor cells, with anachromasis nuclei and hetermorphism, arranged in nested structure, and intercellular bridge was found between the tumor cells in some areas; others were composed of atypical cytotrophoblasts with large pleomorphic nuclei and abundant clear cytoplasm as well as a smaller number of syncytiotrophoblasts with multiple hyperchromatic nuclei and deeply basophilic cytoplasm. Mitotic figures were numerous. Cytotrophoblasts exhibited a diffuse, sheet-like proliferation, and syncytiotrophoblasts tended to cover the surface of the cytotrophoblastic cell nests. Primary choriocarcinoma combined with adenosquamous carcinoma of lung was diagnosed, The histopathological features of other two cases were similar to the small part of the tumor in the first case. Immunohistochemical staining for HCG, CK and EMA revealed positive, and negative for vimentin, NSE, S-100 and CEA. Conchtsions Primary chofiocarcinoma of lung in males is very rare. More sections should be observed and history understood fully in order to exclude metastatic lesions. Histologically, it should be differentiated from giant-cell carcinoma of the lung.