16例新分类大细胞肺癌的临床病理分析  

Clinicopathologic characteristics of large cell lung carcinoma according to the WHO new histological classification

作　　者：王康玮[1,2] 陈少红[1] 杨静[1] 刘国荣[1] 杜洪[1] 魏树全[3] Wang Kangwei;Chen Shaohong;Yang Jing;Liu Guorong;Du Hong;Wei Shuquan(Guangzhou First People’s Hospital, Guangzhou 510180)

机构地区：[1]广州市第一人民医院病理科,广州510180 [2]广州市南沙中心医院病理科,广州511455 [3]广州市第一人民医院呼吸内科,广州510180

出　　处：《新医学》2016年第10期666-670,共5页Journal of New Medicine

基　　金：广东省医学科学技术研究基金(A2015385)

摘　　要：目的分析新分类标准原发性大细胞肺癌（LCLC)的临床病理特点。方法按照2015年WHO肺癌新分类标准，对16例确诊为LCLC的病例进行回顾性分析，观察其组织病理学特征、临床表现、治疗及其预后。结果16例LCLC患者的组织学标本中，所有肿瘤细胞高分子细胞角蛋白（HCK)均阳性，过碘酸雪夫染色均阴性。患者男15例、女1例，年龄64(48~79)岁。TNM分期I期2例，n期1例，m期5例，iv期8例；晚期（m~iv期）患者共13例，占8i%。肿瘤最大径3.6(1.1~7.3)cm。脑转移5例，颈淋巴结转移2例，椎体转移1例。影像学表现为周围型13例（81.3%)。有吸烟史者13例（81.3%)。8例行肺叶切除术联合术后化学治疗，5例行脑转移瘤切除术联合术后化学治疗，2例行颈部转移瘤切除术联合术后化学治疗，1例行椎体转移瘤切除术后联合化学治疗。全组中位生存期10.5个月，1、2、3年生存率分别为38%、38%和25%。结论LCLC发病率低，是一种高度侵袭性的恶性肿瘤，分化差，恶性程度高，临床特征不典型，治疗手段有限，早期发现行手术治疗是最佳选择。Objective To analyze clinicopathologic characteristics of idiopathic large cell lung carcinoma (LCLC) according to WHO new histological classification of lung cancer. Methods According to the 2015 WHO histological classification, clinical data of 16 LCLC cases were reviewed. The histopathologic characteristics, clinical manifestations, treatment and prognosis were observed. Results All 16 histological specimenswere positive for HCK and negative for PAS staining. Fifteen patients were male and one female, aged 64(range 48-79) years on average. Based upon the TNM staging system, 2 cases were stage I , 1 stage I I , 5stage HI and 8 stage IV. Thirteen cases (8 1 % ) were classified as the advanced stage ( stage HI-IV). Themean maximum diameter of tumor was 3. 6 ( range 1. 1-7. 3 ) cm. Five patients had brain metastases, 2 presentedwith neck lymph node metastases and one vertebral metastasis. Imaging examination revealed that 13 cases(81. 3% ) were peripheral type nodules. Thirteen patients (81. 3% ) were smokers. Eight patients underwentlobectomy combined with postoperative chemotherapy, 5 received resection of brain metastasis tumor and chemotherapy,2 resection of neck lymph node metastasis tumor combined with chemotherapy, and 1 resection ofvertebral metastasis tumor plus chemotherapy. The median survival was 10. 5 months. The 1 -,2- and 3-yearsurvival rate of all cases were 38% , 38% and 25% , respectively. Conclusions LCLC is a type of rare,highly-invasive, poor differentiated and highly malignant tumor. LCLC patients present atypical clinical characteristics.Currently, clinical therapies for LCLC are limited. Early diagnosis and surgical resection remain the optimal choice.

关 键 词：大细胞肺癌 肺癌 临床病理分析 

分 类 号：R734.2[医药卫生—肿瘤]