Miyaoka Masashi, Hatanaka Kazuhito, Iwazaki Masayuki, Nakamura Naoya
1 Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Int J Surg Pathol. 2018 Aug;26(5):464-468. doi: 10.1177/1066896918756737. Epub 2018 Feb 7.
We report a rare case of pulmonary enteric adenocarcinoma (PEA) exhibiting a immunohistochemical feature of CK7/CK20 double-negativity by evaluating the transformation zone between PEA and conventional pulmonary adenocarcinoma (CPA). A 75-year-old man was found to have a mass, 40 mm in diameter, in the right lower lobe on chest computed tomography, and underwent right lower lobectomy. Histologically, the tumor was composed of a PEA and CPA component. The dominant PEA component had medium to large complex glands with tall columnar cells with eosinophilic cytoplasm and brush-border. The CPA component comprised small to medium glands with cuboidal cells. Moreover, intermediate glands (INT), which had cuboidal to tall columnar cells, with morphological features between PEA and CPA, was also observed in the transformation area. Immunohistochemically, the PEA component was negative for CK7, CK20, and TTF-1, and positive for CDX2 and SATB2 (weak): the CPA component was negative for CK20, CDX2, and SATB2, and positive for CK7 and TTF-1: the INT were negative for SATB2, with intermingled positive signals for CK7, CK20, TTF-1, and CDX2. The final diagnosis was PEA based on the CPA component and not colorectal carcinoma. To distinguish CK7-negative PEA from metastatic colorectal carcinoma, careful examination for a CPA component is very useful along with clinical information. There are no reports that discuss about process of oncogenesis, de novo sequence or transformation from CPA of PEA. This is the first reported case of CK7/CK20 double-negative PEA, with analysis of the transformation zone between PEA and CPA components.
通过评估肺肠型腺癌（PEA）与传统肺腺癌（CPA）之间的转化区域，我们报告了一例罕见的肺肠型腺癌，其具有CK7/CK20双阴性的免疫组化特征。一名75岁男性在胸部计算机断层扫描中发现右下叶有一个直径40mm的肿块，随后接受了右下叶切除术。组织学上，肿瘤由PEA和CPA成分组成。主要的PEA成分由中等至大型的复杂腺体组成，腺体中有高柱状细胞，细胞质嗜酸性且有刷状缘。CPA成分由小至中等大小的腺体组成，细胞为立方形。此外，在转化区域还观察到中间腺体（INT），其细胞为立方形至高柱状，形态特征介于PEA和CPA之间。免疫组化显示，PEA成分CK7、CK20和TTF-1阴性，CDX2和SATB2阳性（弱阳性）；CPA成分CK20、CDX2和SATB2阴性，CK7和TTF-1阳性；INT的SATB2阴性，CK7、CK20、TTF-1和CDX2呈混合阳性信号。最终诊断为基于CPA成分的PEA，而非结直肠癌。为了将CK7阴性的PEA与转移性结直肠癌区分开来，仔细检查CPA成分并结合临床信息非常有用。目前尚无关于PEA的肿瘤发生过程、从头序列或从CPA转化的报道。这是首例报道的CK7/CK20双阴性PEA病例，并对PEA和CPA成分之间的转化区域进行了分析。
