肺典型类癌临床病理分析  

Clinicopathological analysis of lung typical carcinoid

作　　者：晏俊 魏薇 丁彩霞 刘越[1] 任栋栋 王晓敏[1] YAN Jun;WEI Wei;DING Caixia;LIU Yue;REN Dongdong;WANG Xiaomin(Pathology Department,Shaanxi Provincial Cancer Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学附属陕西省肿瘤医院病理科,陕西西安710061

出　　处：《临床医学研究与实践》2023年第34期18-22,共5页Clinical Research and Practice

基　　金：陕西省肿瘤医院2022年度院内国家自然科学基因孵育项目(No.SC222710)。

摘　　要：目的探讨肺典型类癌(TC)镜下形态、免疫组织化学染色特点、微卫星不稳定性检测、PD-L1表达及临床特征。方法回顾6例肺TC的临床病理资料,总结6例肺TC大体及镜下特征,分析突触素(Syn)、嗜铬素A(Cg A)、CD56、CKpan、CKL、Ki67、CD34、CK7、TTF-1、S100的表达;进行微卫星不稳定性及PD-L1检测,并进行随访。结果肺TC结节界限清楚,切面灰白色、灰黑色。镜下瘤细胞小而一致,核位于中央,极少或无分裂象,胞浆中等细颗粒状;瘤细胞大部分排列成实性团巢状、缎带状和花边状,局灶呈弥漫性片状分布,部分区域可见小腺管似菊形团样结构,少数细胞呈短梭形;瘤组织血窦丰富,间质伴明显玻璃样变,见少许灶状钙化或骨化。免疫组织化学结果显示,Syn、Cg A、CD56、CKpan、CKL均阳性;Ki67增殖指数1%~3%;CD34、CK7、TTF-1、S100均阴性。微卫星不稳定性检测结果显示,6例类癌均为微卫星稳定(MSS)。PD-L1检测结果显示,4例为阴性,2例肿瘤综合阳性评分(CPS)为1。结论肺TC是一类低度恶性神经内分泌肿瘤,常以手术切除为主,其诊断依据形态结合免疫组织化学。6例MSS,PD-L1阴性或低表达。Objective To investigate the microscopic morphology,immunohistochemical staining characteristics,microsatellite instability,programmed cell death-ligand 1(PD-L1)expression and clinical characteristics of lung typical carcinoid(TC).Methods The clinicopathological data of 6 cases of lung TC were reviewed.The gross and microscopic features of lung TC were summarized.The expressions of synaptophysin(Syn),chromogranin A(CgA),CD56,CKpan,CKL,Ki67,CD34,CK7,TTF-1 and S100 were analyzed.Microsatellite instability and PD-L1 were detected and the 6 cases were followed up.Results The boundaries of lung TC nodules in 6 cases were clear,and the sections were gray-white and gray-black.The tumor cells were small and consistent under the microscope,the nucleus was located in the center,with little or no mitotic image,and the cytoplasm was medium-fine granular;most of the tumor cells were arranged in solid mass nests,ribbons and lace-like,and the foci were diffusely distributed in patches,in some areas,small glandular tubes were seen as chrysanthemum-like mass-like structures,and a few cells were short spindle-shaped;the blood sinuses of the tumor tissue were abundant,and the interstitium was obviously glassy,with a few focal calcification or ossification.Immunohistochemical results showed that Syn,CgA,CD56,CKpan and CKL were positive;Ki67 proliferation index was 1%-3%;CD34,CK7,TTF-1 and S100 were all negative.The results of microsatellite instability detection showed that 6 cases of carcinoid were microsatellite stable(MSS).PD-L1 test results showed that 4 cases were negative,and 2 cases of combined positive score(CPS)were 1.Conclusion Lung TC is a kind of low-grade malignant neuroendocrine tumor,which is often treated by surgical resection,and its diagnosis is based on morphology combined with immunohistochemistry.Six cases have MSS and negative or low expression of PD-L1.

关 键 词：肺典型类癌 免疫组织化学 不典型类癌 

分 类 号：R256.4[医药卫生—中医内科学]