肺原发性肝样腺癌临床病理特征研究
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摘要
目的分析肺肝样腺癌(HAL)的临床病理特征、诊断、免疫表型、基因检测及治疗预后等。方法对1例HAL临床及影像学、组织学形态、免疫组化及基因检测结果等进行观察,并结合相关文献综合分析。结果患者为48岁吸烟男性,镜下肿瘤具有肝细胞样和腺样分化特征,血清AFP升高。免疫组化:Hepatocyte,AFP, Arginase-1均阳性,ARMS-PCR法均未检测到EGFR,ALK/ROS1,KRAS及BRAF突变。结合相关文献分析:HAL常见于有吸烟史的男性,血清AFP值升高也是该肿瘤的一个特点。肿物多见于肺上叶,体积较大,易发生淋巴结和远处转移,预后相对较差。结论 HAL非常少见,易误诊,其诊断需结合形态学特点、临床病理特征及免疫组化结果等。
Objective To explore the clinicopathologic characteristics, diagnosis, immunophenotype, gene detection and prognosis of primary hepatoid adenocarcinoma of the lung(HAL). Methods A case of hepatoid adenocarcinoma of the lung was analyzed with clinical manifestations, histology, immunohistochemical staining and gene detection, and relevant literatures were reviewed. Results The patient was a 48-years-old man with smoking history. Microscopically, the tumor has the characteristics of hepatocellular carcinoma and adenoid differentiation, also serum AFP was elevated. The immunohistochemical results showed that Hepatocyte, AFP and Arginase-1 were positive. No mutations were detected for EGFR, ALK/ROS1, KRAS and BRAF by ARMS-PCR. Combining with literature analysis, HAL is common in males and most patients with this tumor are smokers. Serum AFP in very high levels has been a distinguishing feature of this tumor. HAL usually presents as a large bulky solitary mass in the upper lobe. Lymph nodes and distant metastases are prone to occur. Therefore, the prognosis is very poor. Conclusion HAL is a rare malignant tumor and easy to be misdiagnosed. The diagnosis of primary hepatoid adenocarcinoma of the lung should be combined with morphological features, clinicopathological features and immunohistochemical findings.
Objective To explore the clinicopathologic characteristics, diagnosis, immunophenotype, gene detection and prognosis of primary hepatoid adenocarcinoma of the lung(HAL). Methods A case of hepatoid adenocarcinoma of the lung was analyzed with clinical manifestations, histology, immunohistochemical staining and gene detection, and relevant literatures were reviewed. Results The patient was a 48-years-old man with smoking history. Microscopically, the tumor has the characteristics of hepatocellular carcinoma and adenoid differentiation, also serum AFP was elevated. The immunohistochemical results showed that Hepatocyte, AFP and Arginase-1 were positive. No mutations were detected for EGFR, ALK/ROS1, KRAS and BRAF by ARMS-PCR. Combining with literature analysis, HAL is common in males and most patients with this tumor are smokers. Serum AFP in very high levels has been a distinguishing feature of this tumor. HAL usually presents as a large bulky solitary mass in the upper lobe. Lymph nodes and distant metastases are prone to occur. Therefore, the prognosis is very poor. Conclusion HAL is a rare malignant tumor and easy to be misdiagnosed. The diagnosis of primary hepatoid adenocarcinoma of the lung should be combined with morphological features, clinicopathological features and immunohistochemical findings.
引文
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[14] BASSE V,SCHICK U,GUEGUEN P,et al.A mismatch repair-deficient hepatoid adenocarcinoma of the lung responding to anti-pd-l1 durvalumab therapy despite no PD-L1 expression [J].J Thorac Oncol,2018,13(7):e120-e122.
[15] VALLE L,THOMAS J,KIM C,et al.Hepatoid adenocarcinoma of the lung metastasizing to the tonsil [J].Mol Clin Oncol,2017,6(5):705-707.
[2] ISHIKURA H,KANDA M,ITO M,et al.Hepatoid adenocarcinoma:a distinctive histological subtype of alpha-fetoprotein-producing lung carcinoma [J].Virchows Arch A Pathol Anat Histopathol,1990,417(1):73-80.
[3] DELORIMIER A,PARK F,ARANHA G V,et al.Hepatoid carcinoma of the stomach [J].Cancer,1993,71(2):293-296.
[4] AUGUSTIN G,JELINCIC Z,TENTOR D,et al.Hepatoid adenocarcinoma of the stomach:case report and short notes on immunohistochemical markers [J].Acta Gastroenterol Belg,2009,72(2):253-256.
[5] HANINGER D M,KLOECKER G H,BOUSAMRA I M,et al.Hepatoid adenocarcinoma of the lung:report of five cases and review of the literature [J].Mod Pathol,2014,27(4):535-542.
[6] SHAIB W,SHARMA R,MOSUNJAC M,et al.Hepatoid adenocarcinoma of the lung:a case report and review of the literature [J].J Gastrointest Cancer,2014,45(Suppl 1):99-102.
[7] KHOZIN S,ROTH M J,RAJAN A,et al.Hepatoid carcinoma of the lung with anaplastic lymphoma kinase gene rearrangement [J].J Thorac Oncol,2012,7(11):e29-e31.
[8] ISHIKURA H,FUKASAWA Y,OGASAWARA K,et al.An AFP-producing gastric carcinoma with features of hepatic differentiation.a case report [J].Cancer,1985,56(4):840-848.
[9] MOKRIM M,BELBARAKA R,ALLAOUI M,et al.Hepatoid adenocarcinoma of the lung:a case report and literature review [J].J Gastrointest Cancer,2012,43 (Suppl 1):S125-S127.
[10] NAGAI E,UEYAMA T,YAO T,et al.Hepatoid adenocarcinoma of the stomach.a clinicopathologic and immunohistochemical analysis [J].Cancer,1993,72 (6):1827-1835.
[11] KHOZIN S,ROTH M J,RAJAN A,et al.Hepatoid carcinoma of the lung with anaplastic lymphoma kinase gene rearrangement [J].J Thorac Oncol,2012,7(11):e29-e31.
[12] GAVRANCIC T,PARK Y H.A novel approach using sorafenib in alpha fetoprotein-producing hepatoid adenocarcinoma of the lung [J].J Natl Compr Canc Netw,2015,13(4):387-391.
[13] CHE Y Q,WANG S,LUO Y,et al.Hepatoid adenocarcinoma of the lung:presenting mediastinal metastasis without transfer to the liver [J].Oncol Lett,2014,8(1):105-110.
[14] BASSE V,SCHICK U,GUEGUEN P,et al.A mismatch repair-deficient hepatoid adenocarcinoma of the lung responding to anti-pd-l1 durvalumab therapy despite no PD-L1 expression [J].J Thorac Oncol,2018,13(7):e120-e122.
[15] VALLE L,THOMAS J,KIM C,et al.Hepatoid adenocarcinoma of the lung metastasizing to the tonsil [J].Mol Clin Oncol,2017,6(5):705-707.