论文部分内容阅读
目的探讨伴神经内分泌分化的小肠转移性肺巨细胞癌的临床病理特点。方法采用光镜、电镜及免疫组化等方法,观察1例伴神经内分泌分化的小肠转移性肺巨细胞癌患者的临床与病理学资料,并复习相关文献。结果患者空肠肠壁有3处瘤结节,瘤细胞呈肉瘤样疏松排列,弥漫浸润肠壁全层,局部累及肠黏膜上皮。瘤细胞体积巨大,形态不规则,多见巨核与多核瘤巨细胞,间质多量中性粒细胞浸润。免疫组化标记显示瘤细胞CK-L、CK7、Vimentin、NSE、CgA和TTF-1(+),而CK20和villin(-)。电镜观察瘤细胞具有上皮特征和神经内分泌颗粒。依据光镜电镜的形态观察与免疫组化检测,再结合以往病史,确诊为伴神经内分泌分化的小肠转移性肺巨细胞癌。结论肺癌肠转移很少见,但当肺癌患者术后出现消化道症状或腹部占位病变时,要首先考虑到肺癌肠转移的可能,尤其肺巨细胞癌更易发生消化道转移。伴有神经内分泌分化的肺巨细胞癌发生小肠转移者预后不良。
Objective To investigate the clinicopathological features of metastatic small cell lung cancer with neuroendocrine differentiation. Methods The clinical and pathological data of one patient with small cell intestinal metastatic pulmonary giant cell carcinoma with neuroendocrine differentiation were observed by light microscopy, electron microscopy and immunohistochemistry. The related literatures were reviewed. Results There were 3 tumor nodules in the jejunum wall of the patients. The tumor cells were sarcomatoid in a loose arrangement with diffuse infiltration of the entire wall of the intestinal wall, involving the intestinal mucosa epithelium locally. Large tumor cells, irregular shape, more common with giant nuclear and multinucleated giant cells, interstitial neutrophil infiltration. Immunohistochemical markers showed that the tumor cells CK-L, CK7, Vimentin, NSE, CgA and TTF-1 (+), while CK20 and villin (-). Electron microscopy tumor cells have epithelial features and neuroendocrine granules. According to the morphological observation and immunohistochemistry of light microscopy electron microscopy, combined with past medical history, diagnosed with neuroendocrine differentiation of small intestine metastatic pulmonary giant cell carcinoma. Conclusions Intestinal metastasis of lung cancer is rare. However, when gastrointestinal symptoms or abdominal mass lesions occur in patients with lung cancer, it is necessary to consider the possibility of intestinal metastasis of lung cancer first, especially in patients with lung giant cell carcinoma. Poor prognosis of patients with small cell metastasis of pulmonary giant cell carcinoma with neuroendocrine differentiation.