Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Department of Medicine, Division of Medical Oncology and Hematology, University of Louisville School of Medicine, Louisville, KY, USA.
Mod Pathol. 2014 Apr;27(4):535-42. doi: 10.1038/modpathol.2013.170. Epub 2013 Sep 13.
The current diagnostic criteria for hepatoid adenocarcinoma of lung include typical acinar or papillary adenocarcinoma and a component resembling hepatocellular carcinoma and expressing α-fetoprotein (AFP). Distinguishing hepatoid adenocarcinoma of lung from hepatocellular carcinoma metastatic to lung is difficult in patients with both lung and liver masses and in patients at risk for lung and liver cancer because of smoking and viral hepatitis, respectively. We studied morphologic features of hepatoid adenocarcinoma of lung and established an immunohistochemical panel to facilitate distinction of hepatoid adenocarcinoma of lung from hepatocellular carcinoma metastatic to lung. Five cases of hepatoid adenocarcinoma of lung were stained with hematoxylin and eosin and mucicarmine for histomorphologic evaluation. The 14-marker immunohistochemical profile was established for hepatoid adenocarcinoma of lung and compared with that of hepatocellular carcinoma. Two cases of hepatoid adenocarcinoma of lung had signet-ring cell components. Three cases were pure hepatoid adenocarcinoma without components of acinar or papillary adenocarcinoma, signet-ring cells or neuroendocrine carcinoma. Like hepatocellular carcinoma, hepatoid adenocarcinoma of lung expresses CK8 (5/5), CK18 (5/5), AFP (3/5) and HepPar1 (5/5), shows cytoplasmic staining with TTF-1 (5/5) and does not express CK14 (0/5). Unlike hepatocellular carcinoma, it expresses CK5/6 (1/5), CK7 (3/5), CK19 (4/5), CK20 (1/5), HEA125 (5/5), MOC31 (5/5), monoclonal CEA (3/5) and napsin A (1/5). An immunohistochemical panel that includes a variety of cytokeratins, monoclonal CEA and EpCAM markers (HEA125 and MOC31) facilitates distinction of hepatoid adenocarcinoma of lung from hepatocellular carcinoma metastatic to lung, especially when correlated with clinical and radiologic findings. We propose modification of the current diagnostic criteria for hepatoid adenocarcinoma of lung. Tumor composition can be either pure hepatoid adenocarcinoma or hepatoid adenocarcinoma with components of typical acinar or papillary adenocarcinoma, signet-ring cells or neuroendocrine carcinoma. AFP expression is not requisite for diagnosis as long as other markers of hepatic differentiation are expressed.
肺肝样腺癌的当前诊断标准包括典型的腺泡或乳头状腺癌和类似于肝细胞癌的成分，并表达α-胎蛋白（AFP）。在同时患有肺和肝肿块的患者以及分别因吸烟和病毒性肝炎而有患肺和肝癌风险的患者中，肺肝样腺癌与转移性至肺的肝细胞癌很难区分。我们研究了肺肝样腺癌的形态学特征，并建立了一个免疫组织化学小组，以帮助区分肺肝样腺癌与转移性至肺的肝细胞癌。对 5 例肺肝样腺癌进行了苏木精和伊红及粘卡红染色，以进行组织形态学评估。建立了肺肝样腺癌的 14 标志物免疫组织化学特征，并与肝细胞癌进行了比较。有 2 例肺肝样腺癌具有印戒细胞成分。有 3 例为纯肝样腺癌，无腺泡或乳头状腺癌、印戒细胞或神经内分泌癌成分。与肝细胞癌一样，肺肝样腺癌表达 CK8（5/5）、CK18（5/5）、AFP（3/5）和 HepPar1（5/5），细胞质染色 TTF-1（5/5），不表达 CK14（0/5）。与肝细胞癌不同，它表达 CK5/6（1/5）、CK7（3/5）、CK19（4/5）、CK20（1/5）、HEA125（5/5）、MOC31（5/5）、单克隆 CEA（3/5）和 napsin A（1/5）。包括各种细胞角蛋白、单克隆 CEA 和 EpCAM 标志物（HEA125 和 MOC31）的免疫组织化学小组有助于区分肺肝样腺癌与转移性至肺的肝细胞癌，尤其是与临床和影像学发现相关联时。我们建议修改肺肝样腺癌的当前诊断标准。肿瘤组成可以是纯肝样腺癌，也可以是具有典型腺泡或乳头状腺癌、印戒细胞或神经内分泌癌成分的肝样腺癌。只要表达其他肝分化标志物，AFP 表达不是诊断所必需的。
