Terada Kazuhiro, Menju Toshi, Date Horoshi, Haga Hironori, Yoshizawa Akihiko
Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Thorac Cancer. 2024 Apr;15(12):1029-1033. doi: 10.1111/1759-7714.15271. Epub 2024 Mar 13.
Most lung carcinomas are subtyped by their morphologies; however, immunohistochemistry is usually performed when it is difficult to determine. The most reliable antibodies for distinguishing lung adenocarcinoma from squamous cell carcinoma are thyroid transcription factor-1 (TTF-1) and p40 (ΔNp63). In general, these markers are mutually exclusive in their expression of lung primary carcinoma; however, a few cases of non-small cell lung carcinoma (NSCLC) with coexpression of both markers have been reported. Examining a tissue microarray of 229 squamous cell carcinomas and 346 adenocarcinomas, we found one case of NSCLC with coexpression of TTF-1 and p40. Herein, we present a 71-year-old man, who had a mass lesion in the left lung apex. A transbronchial lung biopsy was performed, revealing NSCLC. He underwent left upper segmentectomy and lymph node dissection. Macroscopically, the mass showed a white-to-tan solid tumor on the cut surface. Microscopically, the tumor was composed of polygonal tumor cells which had round and vesicular nuclei with prominent nucleoli. They had an abundant amount of cytoplasm, which was slightly eosinophilic or amphophilic. Multinucleated cells with atypical nuclear features were observed to be scattered in some areas. Multifocal necrosis and hemorrhage were also noted. Distinct squamous features and obvious glandular features were absent. Immunohistochemically, the most tumor cells were coexpressed positive for both TTF-1 and p40. In our study, NSCLC with TTF-1 and p40 coexpression is rare; therefore, it is necessary to obtain further data and examine similar cases to establish more precise definitions and clinicopathological features.
大多数肺癌通过其形态进行亚型分类；然而，当难以确定时通常会进行免疫组织化学检查。用于区分肺腺癌和鳞状细胞癌的最可靠抗体是甲状腺转录因子-1（TTF-1）和p40（ΔNp63）。一般来说，这些标志物在肺原发性癌的表达中相互排斥；然而，已有少数非小细胞肺癌（NSCLC）同时表达这两种标志物的病例报道。通过检查229例鳞状细胞癌和346例腺癌的组织芯片，我们发现1例NSCLC同时表达TTF-1和p40。在此，我们报告一名71岁男性，其左肺尖有一肿块病变。进行了经支气管肺活检，结果显示为NSCLC。他接受了左上叶切除术和淋巴结清扫术。宏观上，肿块在切面上呈灰白色至黄褐色实性肿瘤。微观上，肿瘤由多角形肿瘤细胞组成，这些细胞具有圆形泡状核，核仁突出。它们有丰富的细胞质，略呈嗜酸性或嗜双色性。在一些区域观察到具有非典型核特征的多核细胞散在分布。还注意到多灶性坏死和出血。未见明显的鳞状特征和明显的腺管特征。免疫组织化学检查显示，大多数肿瘤细胞TTF-1和p40均呈共表达阳性。在我们的研究中，TTF-1和p40共表达的NSCLC很罕见；因此，有必要获取更多数据并检查类似病例，以建立更精确的定义和临床病理特征。
