肺转移性腺样囊性癌3例临床病理观察  

Adenoid cystic carcinoma with lung metastases:a clinicopathologic study of three cases

作　　者：霍真[1] 孟云霄[1] 毕娅兰[1] 李媛[1] 张淑英[1] 罗玉凤[1] 曹金伶[1] 梁智勇[1] 

机构地区：[1]中国医学科学院 北京协和医学院 北京协和医院病理科,北京100730

出　　处：《诊断病理学杂志》2014年第11期672-675,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的 报道3例肺转移性腺样囊性癌（ACC）,并总结分析此类疾病的临床病理特征.方法 通过组织形态、免疫组化及组织化学染色分析其临床病理特征及免疫组化特点.结果 3例肺转移性ACC患者年龄分别为37岁、54岁和60岁,男女之比为2∶1;既往均有头颈部腺样囊性癌病史,确诊后9-14年（平均11年）出现肺内结节.胸部CT或X线检查示肺内多发结节,未见气管病变.1例经皮肺穿刺活检,2例行肺楔形切除术.镜下示3例均为筛状/管状型,未见实性区及高级别转化区域.3例均可见粉染基底膜样物质和蓝染黏液样物.3例随访3-48个月（平均25个月）,1例穿刺确诊后接受化疗,23个月后死亡;2例肺楔形切除术后放疗,病灶缩小,未见其他脏器受累.免疫组化：3例CD117、bcl-2和p16均（＋）;SMA和p63肌上皮（＋）;3例基底膜样物胶原Ⅳ均（＋）;3例GFAP及TTF-1均（-）;仅1例p53（＋）;Ki-67阳性指数2％-10％,平均6％.组织化学：3例AB/PAS均（＋）.结论 肺内原发性ACC非常罕见,诊断应首先排除转移性.筛状/管状型ACC转移到肺可以经历较长时间,发现肺内多发结节应考虑到转移癌.手术切除及术后放疗有助于治疗.Objective To investigate the clinical features,pathological and differential diagnosis of adenoid cystic carcinoma （ACC） with lung metastases.Methods All the clinical and histiological findings,immunohistochemistry,histochemistry,treatment and prognosis in all 3 cases of ACC were evaluated with review of the relevant literatures.Results Three cases of ACC with lung metastases included 1 female and 2 males,aged 37-60 years （mean 50 years）.One patient metastases came from salivary gland 10 years after resected,one from ear canal ACC 9 years after resected,and one from salivary ACC resected 14 years ago.CT scan found multiple nodes in all three patients.One case was composed of cribriform pattern,two cases were composed of a combination of cribriform and tubular growth pattern.Both basement membrane and glycosaminoglycan materials were seen.Immunohistochemical studies showed positive reactions for CD117,P16,BCL-2,with myoepithelial reactivity with P63,SMA.GFAP and TTF-1 were negative.P53 was positive in one case.Overall mean follow-up time was 25 months （range 3-48 months）：one patient died of diease （after 23 months）,two were alive with disease （with follow-up time of 48 and 3 months,respectively）.Conclusion Lung primary adenoid cystic carcinoma is very rare,and metastases from other sites to lung should be first ruled out.ACC with cribriform/tubular pattern from other site metastases to lung may experience a long time,so metastatic cancer as a differiential diagnosis when multiple pulmonary nodules should be taken into concern.Treatment for ACC mainly includes resection and postoperative irradiation.

关 键 词：肺 转移性 腺样囊性癌 免疫组化 组织化学 

分 类 号：R739.8[医药卫生—肿瘤]