肺转移性肿瘤临床病理学特征分析  

Clinicopathological analysis of lung metastatic tumor

作　　者：娄宁 牛一茹 杨帆[1] 卢朝辉[1] Lou Ning;Niu Yiru;Yang Fan;Lu Zhaohui(Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100730,China)

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,100730

出　　处：《中华病理学杂志》2021年第9期1039-1044,共6页Chinese Journal of Pathology

基　　金：国家自然科学基金(81672648);中国医学科学院医学与健康科技创新工程项目(2016-I2M-1-001)。

摘　　要：目的探讨肺转移性肿瘤的临床病理特征及鉴别诊断方法。方法收集中国医学科学院北京协和医学院北京协和医院病理科2014年1月至2018年12月诊断明确的肺转移性肿瘤226例的临床病理资料,观察病理形态学特点,并借助免疫组织化学染色进行鉴别诊断。结果患者中男性84例,女性142例,年龄范围13~77岁,肺多发性结节者122例,单发性结节者104例。常见肺转移性肿瘤按照来源部位依次为结直肠59例,滋养细胞肿瘤44例,肾31例,乳腺20例,宫颈14例,尿路上皮8例。原发肿瘤距离转移时间、是否行手术治疗等因疾病而异。肺转移性肿瘤与原发肿瘤病理形态学有一定的重叠,阅片时应仔细寻找相对特异性的形态学特点及肿瘤周边有无原位癌区域等以资鉴别;肺转移性肿瘤免疫组织化学染色常甲状腺转录因子1(TTF1)阴性,与原发性肿瘤鉴别均需依据相对特异抗体:结直肠癌细胞角蛋白(CK)20、CDX2阳性,CK7阴性;恶性滋养细胞肿瘤人绒毛膜促性腺激素(HCG)阳性;肾透明细胞癌CD10、波形蛋白阳性,CK7阴性;乳腺癌GATA3、雌激素受体阳性;宫颈癌p16阳性;尿路上皮癌CK20、p63、GATA3阳性。结论肺转移性肿瘤与原发性肿瘤在临床病理特征上有重叠,确诊需要紧密结合临床特征、病理学形态及免疫表型特征综合分析判断。Objective To investigate the clinicopathological features and differential diagnosis of metastatic tumors in the lung.Methods The clinicopathological data of 226 metastatic tumors in the lung were collected at Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,from January 2014 to December 2018,and the pathomorphological characteristics were analyzed.Results There were 84 males and 142 females,with an age range from 13 to 77 years.There were 122 patients with multiple pulmonary nodules and 104 patients with solitary pulmonary nodule.The tumors of the highest frequencies were colorectal cancer(n=59),followed by trophoblast tumor(n=44),kidney cancer(n=31),breast cancer(n=20),cervix cancer(n=14),and urinary urothelium cancer(n=8).The time from the diagnosis of primary tumors to metastasis and the status of surgical treatment varied by tumor origin.The morphology of metastatic lung tumors overlapped with that of the primary tumors to some extent.The relative specific morphological characteristics and the presence of carcinoma in situ surrounding the tumors should be carefully searched for to confirm the tumor origin.The metastatic tumors of the lung had morphological characteristics,immunohistochemical TTF1(-)and tumor of various sources,while the primary tumor differentiation had relatively specific antibodies:colorectal cancer CK20(+),CDX2(+),CK7(-);malignant trophoblastic tumor,HCG(+);renal clear cell carcinoma CD10(+),vimentin(+),CK7(-);breast cancer,GATA3 and ER(+);cervical cancer,p16(+);urothelial carcinoma,CK20,p63 and GATA3(+).Conclusions There is overlap between pulmonary metastatic tumor and primary tumor in morphology.Therefore,the diagnosis should be made by combining clinical history,pathological morphology and immunophenotypic characteristics.

关 键 词：肺肿瘤 肿瘤转移 诊断 鉴别 免疫组织化学 

分 类 号：R734.2[医药卫生—肿瘤]