Sun Wen-Wen, Xu Zhi-Hong, Wang Chao-Fu, Wu Fang, Cao Jiu-Mei, Cui Pei-Jing, Huang Wei, Jin Xiao-Long, Li Biao, Chen Ke-Min, Gao Bei-Li, Hu Jia-An
Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China.
Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 200025, P.R. China.
Oncol Lett. 2017 Jun;13(6):4651-4656. doi: 10.3892/ol.2017.6060. Epub 2017 Apr 20.
Pulmonary enteric adenocarcinoma is a markedly rare pathological type of lung adenocarcinoma. As the pancreas is a relatively uncommon site for metastasis, the present case is even more unusual. A 62-year-old male was admitted to hospital following the identification of masses in the left chest wall, right abdominal wall and right upper limb, but with no respiratory symptoms. Computed tomography (CT) of the chest revealed a lump in the lung and a mass in the left chest wall, and F-fluorodeoxyglucose (F-FDG) uptake by the lumps was increased. An enhanced abdominal CT revealed a hypodense and homogeneous mass on the head of the pancreas, which was slightly enhanced compared with normal pancreatic tissue. In addition, the F-FDG uptake of the lesion was increased and the standardized uptake value (SUV) delayed was not evidently decreased compared with SUVearly. A number of other abnormal metabolic lesions were also identified using positron emission tomography/CT, whereas no abnormal F-FDG uptake was identified in the gastrointestinal organ. Furthermore, rectocolonoscopy was performed to exclude diagnosis of metastatic colorectal adenocarcinoma. The hematoxylin- and eosin-stained smears of the masses in the right lung and left chest demonstrated an enteric pattern, which shared morphological and immunohistochemical (IHC) features with those of colorectal adenocarcinoma. The IHC detection revealed that the lesions in the right lung were positive for cytokeratin 7 (CK7), and negative for CK20 and thyroid transcription factor 1 (TTF-1), and the expression of caudal type homeobox 2 (CDX2) was weakly positive; the masses in the left chest wall were positive for CK7, negative for TTF-1, and CK20 and CDX2 were weakly expressed.
肺肠型腺癌是肺腺癌中一种极为罕见的病理类型。由于胰腺是相对不常见的转移部位，本病例更为特殊。一名62岁男性因在左胸壁、右腹壁和右上肢发现肿块入院，但无呼吸道症状。胸部计算机断层扫描（CT）显示肺部有一个肿块以及左胸壁有一个肿物，这些肿物的氟脱氧葡萄糖（F-FDG）摄取增加。增强腹部CT显示胰腺头部有一个低密度且均匀的肿物，与正常胰腺组织相比略有强化。此外，该病变的F-FDG摄取增加，延迟标准化摄取值（SUV）与早期SUV相比无明显下降。使用正电子发射断层扫描/CT还发现了一些其他异常代谢病变，而在胃肠道器官未发现异常F-FDG摄取。此外，进行了直肠结肠镜检查以排除转移性结直肠癌的诊断。右肺和左胸壁肿物的苏木精-伊红染色涂片显示为肠型，在形态学和免疫组织化学（IHC）特征上与结直肠癌相似。IHC检测显示右肺病变细胞角蛋白7（CK7）呈阳性，细胞角蛋白20（CK20）和甲状腺转录因子1（TTF-1）呈阴性，尾型同源框2（CDX2）表达弱阳性；左胸壁肿物CK7呈阳性，TTF-1呈阴性，CK20和CDX2弱表达。
