Yu Xiangyang, Ye Xiaoxing, Zhang Mengqi, Huang Wenting, Ng Calvin S H, Yu Zhentao, Ma Kai
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Ther Adv Med Oncol. 2025 Jul 29;17:17588359251357520. doi: 10.1177/17588359251357520. eCollection 2025.
Secretory carcinoma (SC) is a newly defined and exceedingly rare pathologic subtype of lung cancer. We present a case of SC that was initially misdiagnosed as stage IIIB (cT2aN3M0) invasive mucinous adenocarcinoma harboring a programmed cell death ligand 1 tumor proportion score of 10% and an - fusion gene. The patient received five cycles of toripalimab and pemetrexed plus carboplatin at a local hospital without treatment-related adverse events. Radiologic evaluations prior to third- and fifth-cycle immunochemotherapy indicated that the best response was stable disease. The patient was subsequently reclassified as having stage IB (cT2aN0M0) primary pulmonary malignancy after invasive N staging at our institution, and the primary tumor and mediastinal lymph nodes were removed via a thoracoscope. The tumor exhibited typical morphologic features of SC with immunohistochemical positivity for Mammaglobin and S100 but not for NapsinA or TTF1. Tumor regression was scarcely observed in the surgically resected specimens. This patient was the fifth reported case of primary SC of the lung and the first case of SC treated with immune checkpoint inhibitor therapy that was evaluated in terms of comprehensive safety and efficacy.
分泌性癌（SC）是一种新定义的且极为罕见的肺癌病理亚型。我们报告一例SC病例，该病例最初被误诊为IIIB期（cT2aN3M0）浸润性黏液腺癌，程序性细胞死亡配体1肿瘤比例分数为10%，且存在 - 融合基因。患者在当地医院接受了5个周期的托瑞帕利单抗、培美曲塞联合卡铂治疗，未出现与治疗相关的不良事件。第三和第五周期免疫化疗前的影像学评估表明，最佳反应为疾病稳定。该患者随后在我院进行侵入性N分期后被重新分类为IB期（cT2aN0M0）原发性肺恶性肿瘤，并通过胸腔镜切除了原发性肿瘤和纵隔淋巴结。肿瘤表现出SC的典型形态学特征，乳腺珠蛋白和S100免疫组化呈阳性，但NapsinA或TTF1呈阴性。在手术切除的标本中几乎未观察到肿瘤消退。该患者是第五例报告的原发性肺SC病例，也是第一例接受免疫检查点抑制剂治疗并对综合安全性和疗效进行评估的SC病例。
