Saito Ryoko, Kasajima Atsuko, Taniuchi Shinji, Fujishima Fumiyoshi, Ishida Kazuyuki, Nakamura Yasuhiro, Yamanda Shinsuke, Takahashi Tohru, Hitomi Hideaki, Murakami Kazuhiro, Watanabe Mika, Sasano Hironobu
Department of Pathology, Tohoku University School of Medicine, Miyagi, Japan.
Pathol Int. 2012 Oct;62(10):709-15. doi: 10.1111/j.1440-1827.2012.02860.x.
We report two autopsy cases of primary pulmonary adenocarcinoma associated with unusual pleural spread. Both patients had confirmed history of asbestos exposure. In the first patient the tumor was localized in one pulmonary lobe with marked infiltration into pleura, chest wall and diaphragm. In the second patient the entire right lung was covered by irregularly thickened tumor. Both tumors were mainly located in the extrapulmonary area and the intrapulmonary portions represented only minor components. Histologically, tumor cells demonstrated glandular and papillary growth patterns associated with focal hobnail-like features. Immunohistochemical evaluation revealed diffuse and marked immunoreactivity of TTF-1, CEA, CD15 and MOC31 in both cases, while calretinin, CK5/6, vimentin, thrombomodulin and HBME-1 were broadly positive in one case. D2-40 was not detected in either case. Examination using electron microscopy revealed the presence of sparse and short microvilli in tumor cells. All of the above findings are consistent with adenocarcinoma of the lung. Primary adenocarcinoma with a characteristic pleural extention grossly resembling malignant mesothelioma has been previously reported in the literature as pseudomesotheliomatous adenocarcinoma. This is the first report of pseudomesotheliomatous adenocarcinoma displaying variable immunoprofile with a diagnosis using electron microscopical examination. Additionally, we performed quantitative analysis of asbestos bodies in pseudomesotheliomatous adenocarcinoma.
我们报告了两例原发性肺腺癌伴不寻常胸膜播散的尸检病例。两名患者均有石棉接触史。首例患者肿瘤局限于一个肺叶，显著浸润至胸膜、胸壁和膈肌。第二例患者整个右肺被不规则增厚的肿瘤覆盖。两个肿瘤主要位于肺外区域，肺内部分仅占小部分。组织学上，肿瘤细胞呈腺管和乳头样生长模式，并伴有局灶性鞋钉样特征。免疫组化评估显示两例患者TTF-1、CEA、CD15和MOC31均呈弥漫性显著免疫反应，而一例患者钙视网膜蛋白、CK5/6、波形蛋白、血栓调节蛋白和HBME-1广泛阳性。两例均未检测到D2-40。电镜检查显示肿瘤细胞存在稀疏且短小的微绒毛。上述所有发现均符合肺腺癌。原发性腺癌伴有特征性胸膜扩展，大体上类似于恶性间皮瘤，先前文献报道为假间皮瘤样腺癌。这是首例关于假间皮瘤样腺癌具有可变免疫表型且通过电镜检查确诊的报道。此外，我们对假间皮瘤样腺癌中的石棉小体进行了定量分析。
