不同组织亚型不同基因型同时性多原发肺癌(附1例病例报道)  

Synchronous Multiple Primary Lung Cancer Dignosed by Different Phenotype-genotype:A Case Report and Literature Review

作　　者：李欣[1] 章智荣[1] 傅毅立[1] 苗劲柏[1] 胡滨[1] 

机构地区：[1]首都医科大学附属北京朝阳医院胸外科,北京100020

出　　处：《中国肺癌杂志》2017年第12期857-860,共4页Chinese Journal of Lung Cancer

摘　　要：随着低剂量螺旋计算机断层扫描(computed tomography,CT)广泛应用于早期肺癌筛查,诊断出的双肺同时多发性病变的病例数逐年增多,且大多数病例最后证实为同时性多原发肺癌(synchronous multiple primary lung cancer,SMPLC)。既往研究结果显示SMPLC的发病率约为0.2%-8%(穿刺研究结果为3.5%-14%)。目前对于MPLC的诊断,大多依据Martini-Melamed的诊断标准:SMPLC:①肺癌部位各异,彼此孤立;②组织学类型不同;③组织学类型相同时,位于不同肺段、肺叶、不同侧肺,由不同的原位癌起源,肺癌共同的淋巴引流部位无癌肿,确立诊断时无肺外转移。异时性多原发肺癌(metachronous multiple primary lung cancer,MMPLC):①组织学类型不同;②组织学类型相同时,无瘤间期至少2年,或均由不同的原位癌起源,或第二原发癌位于不同肺叶或不同侧肺时,肺癌共同的淋巴引流部位无癌肿,确立诊断时无肺外转移。而各个肿瘤具有独特的病理形态特征为诊断MPLC的要点。此后很多学者在这条标准的基础上进行了不断的修订与丰富,包括国际肺癌研究协会(International Association for the Study of Lung Cancer,IASLC)新版肺腺癌分类及表皮生长因子受体(epidermal growth factor receptor,EGFR)、K-ras基因突变等,这些内容的增加使多原发癌灶与转移灶的鉴别诊断标准更加合理准确,也同时说明对于MPLC的各个病灶分别进行基因检测具有重要的鉴别和治疗意义。现将我院胸外科术后病理证实为不同组织亚型、不同基因型的同时性四原发肺癌患者诊治情况报道如下。In recent years, based on low-dose computed tomography （CT） scan developed for physical examination, the number of synchronous multiple primary lung cancer （SMPLC） has gradually increased. The research showed the morbidity of SMPLC up to 0.2%-8%. The current diagnostic criteria of SMPLC is Martini-Melamed criteria. SMPLC： （1） Tumours should be located distantly and separately; （2） Histological types： Different histology; If same histolog）5 they should be located at different segment, lobe or lung and originated from carcinoma insitu. No presence of carcinoma at shared lymphatic drainage. No extrapulmonary metastases at the diagnosis. MMPLC： （1） Different histology; （2） Disease free duration more than 2 years. Originated from carcinoma in situ location of second cancer at different lobe or lung. No presence of carcinoma at shared lymphatic drainage. No extrapulmonary metastases at the diagnosis. In 2013 International association for lung cancer research （IASLC） amended and supplemented the Martini-Melamed criteria, by multidisciplinary classification of lung adeno- carcinoma, epidermal growth factor receptor （EGFR）, K-ras added for differential diagnosis. It also suggest that the gene mutation detection for each lesion of SMPLC is especially significant for therapeutic strategy. We herein report the case of a 60-year- old woman diagnosed with SMPLC of four adenocarcinoma and EGFR-mutated lesions, who received lung resection for each lesions.

关 键 词：多原发癌 病理亚型 EGFR 肺肿瘤 

分 类 号：R734.2[医药卫生—肿瘤]