天津医药

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肺原发性印戒细胞癌临床病理学观察

王承志1,李莘2,章明放3   

  1. 1. 天津市海河医院
    2. 天津市海河医院病理科
    3. 天津医科大学
  • 收稿日期:2011-05-27 修回日期:2011-11-08 出版日期:2012-02-15 发布日期:2012-02-15
  • 通讯作者: 王承志

Clinical pathology review of lung primary signet-ring cell carcinoma

  • Received:2011-05-27 Revised:2011-11-08 Published:2012-02-15 Online:2012-02-15

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摘要： 摘要 目的：探讨肺原发性印戒细胞癌的临床病理特点及生物学特征。方法：对8例肺原发性印戒细胞癌患者的肿瘤组织病理学进行分析观察、并对细胞角蛋白广谱（Ckpan）、细胞角蛋白7（CK7 ）、细胞角蛋白20（CK20）、血管内皮生长因子（VEGF）、甲状腺转录因子-1（TTF-1）等指标进行免疫组织化学染色和AB及PAS特殊染色。结果：患者临床症状缺乏特异性，以咳嗽、咳痰为主。影像学均表现为肺周边型的结节状肿物，边界不清，直径2.5~5.5 cm。光镜下见肿瘤细胞中等大小、圆形、胞质内含大量黏液，形成圆形黏液滴，推挤细胞核至一侧，呈印戒样外观。特殊染色AB及PAS全部阳性；免疫组化结果CKpan及癌胚抗原（CEA）8例全部阳性，CK7、TTF-1及VEGF阳性7例，CK20阳性1例。结论：肺原发性印戒细胞癌临床上罕见，恶性程度高，易发生侵袭与转移，预后不佳。确诊主要依靠病理及免疫组化检查，其中TTF-1、CK7及CK20有助于鉴别原发与转移性印戒细胞癌。

关键词: 癌, 印戒细胞, 肺肿瘤, 肿瘤, 多原发性, 免疫组织化学, 病理学, 临床

Abstract: Abstract Objective: to discuss the clinical pathology features and biologic characters of lung primary signet-ring cell carcinoma. Methods: to observe the histopathology features of 8 cases of lung primary signet-ring cell carcinoma，immunohistochemistry staining with cytokeratin pan (CKpan), cytokeratin 7 (CK7), cytokeratin 20 (CK20), vascular endothelial growth factor(VEGF) and thyroid transcription factor-1 (TTF-1)and special staining with AB and PAS in the all cases. Results: patients with lung primary signet-ring cell carcinoma present with cough and expectoration, and clinical symptoms are deficient with specificity. Nodule masses are present in periphery of lung by imaging, which have no unclear border and the diameters are 2.5-5.5cm. tumor cells are moderate size， round， and contain considerable mucin， which push against cell nucleus creating a signet ring cell appearance under light microscope. These special stains with AB and PAS are all positive. The immunohistochemical stains with CKpan and carcinoembryonic antigen (CEA) are all positive, 7 of 8 patients with CK7, TTF-1 and VEGF are positive, 1 of 8 patients with CK20 is positive.Conclusion: lung primary signet-ring cell carcinoma is scarce， high malignancy， tending to spread and metastasis. The final diagnosis depends on pathology and immunohistochemistry stain, TTF-1, CK7 and CK20 may help differentiate primary and metastatic signet-ring cell carcinoma.

Key words: carcinoma, signet ring cell lung neoplasms neoplasms, multiple primary immunohistochemistry pathology, clinical, 临床