Li Hong C, Schmidt Lindsay, Greenson Joel K, Chang Andrew C, Myers Jeffrey L
Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA.
Am J Clin Pathol. 2009 Jan;131(1):129-33. doi: 10.1309/AJCPB04XWICTFERL.
Pulmonary adenocarcinoma with intestinal differentiation is rare and typically expresses proteins common to lung primaries. We report a case in a 51-year-old woman with a solitary 3.3-cm mass in the left lower lobe. Additional clinical investigation, including positron emission tomography scan with fluorine 18-labeled fluorodeoxyglucose, colonoscopy, and capsule endoscopy of her small bowel, revealed no evidence of tumor elsewhere. She underwent left lower lobectomy with mediastinal lymphadenectomy. Histologic examination revealed tall columnar cells without goblet cell differentiation arranged in a cribriform and acinar pattern with extensive central necrosis. Metastatic carcinoma was present in multiple hilar lymph nodes. Mediastinal lymph nodes were negative. Immunohistochemical stains demonstrated diffuse positivity for cytokeratin (CK) 20 and CDX-2 in neoplastic cells with negative staining for CK7 and thyroid transcription factor-1. CK7 expression has been documented in all 14 cases previously reported. This is the first description of pulmonary adenocarcinoma with intestinal differentiation with histopathologic and immunophenotypic findings indistinguishable from metastatic colorectal adenocarcinoma.
具有肠化生的肺腺癌较为罕见，通常表达原发性肺癌常见的蛋白。我们报告一例51岁女性患者，其左下叶有一个3.3厘米的孤立肿块。包括使用氟-18标记的氟脱氧葡萄糖进行正电子发射断层扫描、结肠镜检查以及小肠胶囊内镜检查在内的进一步临床检查，未发现其他部位有肿瘤迹象。她接受了左下叶切除术及纵隔淋巴结清扫术。组织学检查显示为高柱状细胞，无杯状细胞分化，呈筛状和腺泡状排列，伴有广泛的中央坏死。多个肺门淋巴结存在转移癌。纵隔淋巴结为阴性。免疫组化染色显示肿瘤细胞中细胞角蛋白（CK）20和CDX-2弥漫阳性，CK7和甲状腺转录因子-1染色阴性。先前报道的14例病例均有CK7表达记录。这是首例具有肠化生的肺腺癌，其组织病理学和免疫表型特征与转移性结直肠癌难以区分的描述。
