Weissferdt Annikka, Kalhor Neda, Rodriguez Canales Jaime, Fujimoto Junya, Wistuba Ignacio I, Moran Cesar A
Department of Pathology, MD Anderson Cancer Center, Houston, TX, 77030, USA.
Department of Pathology, MD Anderson Cancer Center, Houston, TX, 77030, USA.
Hum Pathol. 2017 Jan;59:1-9. doi: 10.1016/j.humpath.2016.08.003. Epub 2016 Aug 25.
Spindle cell and pleomorphic carcinomas are currently grouped among sarcomatoid carcinomas of the lung. Because of their unusual occurrence, these tumors have not been properly assessed by immunohistochemistry. We performed a comprehensive immunohistochemical analysis of 86 of these tumors. Seventy-four pleomorphic carcinomas (57 with differentiated elements) and 12 spindle cell carcinomas were subjected to immunohistochemistry with CAM5.2, cytokeratin (CK) 7, thyroid transcription factor 1, napsin A, CK5/6, p40, desmocollin 3, Sox2, calretinin, and D2-40. The percentage of positive tumor cells as well as the staining intensity were evaluated and scored. The spindle/giant elements were positive for CAM5.2 (93%), CK7 (79%), thyroid transcription factor 1 (41%), napsin A (20%), calretinin (20%), Sox2 (13%), CK5/6 (9%), p40 (8%), D2-40 (6%), and desmocollin 3 (3%). Of 29 cases in which immunohistochemistry was performed on spindle/giant cell and corresponding differentiated elements, 21 (72%) showed a consistent staining pattern in both components, whereas in 8 cases (28%), the immunophenotype in the spindle/giant cells was less lineage-specific than in the differentiated component. Therefore, we consider that 42% of neoplasms otherwise classified as sarcomatoid carcinoma can be reclassified as adenocarcinoma and 14% as squamous cell carcinoma, while the remaining 44% failed to show a more specific immunophenotype. The use of a comprehensive immunohistochemical panel allows reclassification of the majority of sarcomatoid carcinomas as poorly differentiated variants of adenocarcinoma or squamous cell carcinoma. Such reclassification will facilitate clinical management and allow molecular testing and pursuit of targeted treatment strategies. Application of immunohistochemistry should become the standard in the workup of pulmonary sarcomatoid carcinomas.
梭形细胞癌和多形性癌目前被归类于肺肉瘤样癌。由于其罕见性，这些肿瘤尚未通过免疫组织化学进行恰当评估。我们对其中86例肿瘤进行了全面的免疫组织化学分析。74例多形性癌（57例伴有分化成分）和12例梭形细胞癌接受了针对CAM5.2、细胞角蛋白（CK）7、甲状腺转录因子1、胃蛋白酶原A、CK5/6、p40、桥粒芯蛋白3、Sox2、钙视网膜蛋白和D2-40的免疫组织化学检测。评估并记录阳性肿瘤细胞的百分比及染色强度。梭形/巨细胞成分对CAM5.2呈阳性（93%）、CK7呈阳性（79%）、甲状腺转录因子1呈阳性（41%）、胃蛋白酶原A呈阳性（20%）、钙视网膜蛋白呈阳性（20%）、Sox2呈阳性（13%）、CK5/6呈阳性（9%）、p40呈阳性（8%）、D2-40呈阳性（6%）、桥粒芯蛋白3呈阳性（3%）。在29例对梭形/巨细胞及相应分化成分进行免疫组织化学检测的病例中，21例（72%）在两个成分中呈现一致的染色模式，而8例（28%）中，梭形/巨细胞的免疫表型比分化成分的谱系特异性更低。因此，我们认为，原本归类为肉瘤样癌的肿瘤中，42%可重新归类为腺癌，14%可重新归类为鳞状细胞癌，其余44%未表现出更具特异性的免疫表型。使用全面的免疫组织化学检测组合可将大多数肉瘤样癌重新归类为腺癌或鳞状细胞癌的低分化变体。这种重新分类将有助于临床管理，并允许进行分子检测及采用靶向治疗策略。免疫组织化学的应用应成为肺肉瘤样癌检查的标准。
