肺肝样腺癌临床特征分析并文献复习（附2例报道）

发布时间：2019-03-16 14:26

【摘要】：目的:探讨肺肝样腺癌(hepatoid adenocarcinoma of lung,HAL)的临床病理特点,提高临床认识,减少漏诊、误诊。方法:回顾性分析我院2例肺肝样腺癌患者临床表现、实验室检查、影像学及病理学资料,并复习相关文献,探讨HAL的临床特点。结果:(1)病例一为50岁男性,既往长期吸烟史,无肝脏疾病史,主要症状为咳嗽、声嘶、胸痛。血清AFP、肝功能未见异常。肺部CT示左肺上叶块状影,支气管镜支刷物涂片可见癌细胞,经皮肺穿刺活检病理诊断肺肝样腺癌,AFP表达阴性。肝脏CT、B超检查等未见异常。患者未行化疗,出院后随访4个月死亡。病例二为58岁男性,既往长期吸烟史,无肝脏疾病史,主要症状为咳嗽、咳痰、胸痛。血清AFP、肝功能正常。肺部CT示左肺下叶大片密度增高影,PET/CT显示代谢增高,病灶肺组织病理示肺肝样腺癌,APF表达阳性。肝脏CT、B超检查等未见异常。患者未行化疗,出院后随访1年半仍存活。(2)文献复习结果:从Pubmed等数据库检索从1990年至2016年12月国内外肺肝样腺癌病例报道文献,检索到40篇文献,病理结果符合肺肝样腺癌,其中男性发病92.5%(37/40),平均发病年龄59.4岁,病变好发于上叶(31/40),纳入症状统计29例,24.1%无症状(7/29),75.8%有症状(22/29),主要呼吸道症状为咳嗽(13/29)、咳痰(5/29)、咯血(5/29)、呼吸困难(5/29)。共26例行影像学检查表现均为单发结节影(26/26),呈类圆形或分叶状,部分有毛刺,靠近肺门及贴近胸壁。多数患者血清AFP增高及免疫组化AFP表达阳性。组织病理类似肝细胞癌,由肝样分化区和腺癌区组成。治疗方法包括手术、化疗、放疗。结论:1.HAL临床少见,多为中老年发病,呈男性发病优势,常有吸烟史,无肝脏疾病史。2.HAL主要呼吸道症状为咳嗽、咳痰、咯血,部分无症状;好发于肺上叶,表现为直径较大单结节,病灶可强化,PET/CT显示高代谢影。3确诊以病灶肺组织病理具有肝细胞癌形态特征为依据,需排除肝癌肺转移。4.HAL癌细胞AFP表达多为阳性,血清AFP水平可增高。
[Abstract]:Objective: to investigate the clinicopathological features of lung hepatoid adenocarcinoma (hepatoid adenocarcinoma of lung,HAL) in order to improve clinical understanding and reduce missed diagnosis and misdiagnosis. Methods: the clinical manifestations, laboratory examination, imaging and pathological data of 2 patients with lung hepatoid adenocarcinoma in our hospital were analyzed retrospectively. The clinical features of HAL were also reviewed. Results: (1) A 50-year-old male had a long history of smoking and no history of liver disease. The main symptoms were cough, hoarseness and chest pain. The liver function of serum AFP, was not abnormal. Lung CT showed a mass shadow of the upper lobe of the left lung. Cancer cells could be seen on bronchoscope brushing smears. AFP expression was negative in liver-like adenocarcinoma of the lung diagnosed by percutaneous lung biopsy. No abnormality was found in CT, examination of liver. The patient did not receive chemotherapy and died after 4 months of follow-up. Case 2 is 58-year-old male, long-term smoking history, no history of liver disease, the main symptoms are cough, expectoration, chest pain. The liver function of serum AFP, was normal. Pulmonary CT showed high density in left inferior lobe, increased metabolism in PET/CT, and positive expression of APF in liver-like adenocarcinoma of lung. No abnormality was found in CT, examination of liver. The patients were followed up for one and a half years after discharge without chemotherapy. (2) the results of literature review: from Pubmed and other databases, 40 articles were retrieved from domestic and foreign reports of lung liver-like adenocarcinoma cases from 1990 to 2016. The pathological results were consistent with that of liver-like adenocarcinoma of the lung, in which 92.5% (37 / 40) were male, the average age of onset was 59.4 years old, the lesion was most common in the upper lobe (31 / 40), and 29 cases (24.1%) were asymptomatic (7 / 29). The main respiratory symptoms were cough (13 / 29), expectoration (5 / 29), hemoptysis (5 / 29) and dyspnea (5 / 29). The imaging findings of 26 cases were single nodular (26 / 26), round or lobulated, with partial burr, close to the hilum and close to the chest wall. Most of the patients had elevated serum AFP and positive expression of immunohistochemical AFP. Histopathology is similar to hepatocellular carcinoma (HCC) and consists of liver-like differentiation and adenocarcinomas. Treatments include surgery, chemotherapy, and radiotherapy. Conclusion: the main respiratory symptoms of 1.HAL are cough, expectoration, hemoptysis, and some of them are asymptomatic, usually have smoking history and have no history of liver disease, the main respiratory symptoms of HAL are cough, expectoration, hemoptysis and so on. Most of the lesions occurred in the upper lobe of the lung, showing a large single nodule in diameter, and the lesions could be enhanced, and PET/CT showed high metabolic shadows. 3 the diagnosis was based on the pathological features of hepatocellular carcinoma in the lung tissue of the lesion, and the diagnosis was based on the pathological features of HCC. 4. The expression of AFP in HAL cancer cells was positive, and the serum AFP level could be increased.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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