Wick M R, Ritter J H, Nappi O
Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University Medical Center, St. Louis, MO 63110, USA.
Hum Pathol. 1995 Sep;26(9):1014-21. doi: 10.1016/0046-8177(95)90092-6.
Although the capacity for some pulmonary carcinomas to mimic sarcomas is well recognized, their potential resemblance to selected benign lesions of the lung is currently underappreciated. The authors herein report three examples of sarcomatoid bronchogenic carcinoma with a deceptively bland appearance and an investment of reactive inflammation, such that they resembled pseudotumors histologically. These lesions occurred in two men and one woman who were 44, 61, and 63 years old, respectively, at diagnosis. All patients presented with a productive cough, hemoptysis, or chest pain. Their pulmonary masses were irregularly marginated radiographically, and ranged in size from 2.5 to 5.5 cm. Two were treated with lobectomy, and one underwent a wedge excision, followed by radiotherapy to the thorax. Despite these measures, each patient with inflammatory sarcomatoid carcinoma (ISC) died of disease or is likely to do so. Microscopically, ISCs were composed of uniform spindle cell proliferations with only modest nuclear pleomorphism, limited mitotic activity, and an arrangement in fascicles, storiform configurations, or haphazard arrays. Lymphocytes and plasma cells were interspersed throughout each of them, and keloidal stromal collagen was apparent internally in two examples. Two of the neoplasms also invaded pulmonary blood vessels or bronchi. A comparison group of 10 adults with pulmonary inflammatory pseudotumors (IPs) of the fibrous histiocytoma type shared several clinical attributes with ISC and showed closely similar histological features, except that the IPs lacked mitoses and invasiveness, and contained xanthoma cells or multinucleated elements in some cases in this series. Immunohistochemical analyses showed consistent dissimilarities between ISC and IP; keratin and epithelial membrane antigen were present in ISC but not IP, whereas actin was observed only in the proliferating spindle cells of IP. In summary, the potential clinicopathologic overlap between ISC and IP suggests that caution should be exercised in the separation of these two lesions. In particular, it is unwise to attempt to make this distinction in an intraoperative frozen section setting.
尽管某些肺癌模仿肉瘤的能力已广为人知，但它们与肺部特定良性病变的潜在相似性目前却未得到充分认识。本文作者报告了三例肉瘤样支气管源性癌，其外观看似平淡，伴有反应性炎症浸润，以至于在组织学上类似于假瘤。这些病变分别发生在两名男性和一名女性身上，诊断时年龄分别为44岁、61岁和63岁。所有患者均有咳痰、咯血或胸痛症状。其肺部肿块在影像学上边界不规则，大小在2.5至5.5厘米之间。两名患者接受了肺叶切除术，一名患者接受了楔形切除术，随后进行了胸部放疗。尽管采取了这些措施，每例炎症性肉瘤样癌（ISC）患者均死于该疾病或很可能如此。显微镜下，ISC由形态一致的梭形细胞增殖构成，核异型性仅为中等程度，有丝分裂活性有限，呈束状、车轮状排列或杂乱无章。淋巴细胞和浆细胞散布于每个病变中，在两例病变内部可见瘢痕样间质胶原。其中两例肿瘤还侵犯了肺血管或支气管。一组由10例纤维组织细胞瘤型肺炎症性假瘤（IP）的成年人组成的对照组与ISC有若干临床特征相同，且组织学特征极为相似，只是IP缺乏有丝分裂和侵袭性，在本系列的某些病例中含有泡沫细胞或多核成分。免疫组织化学分析显示ISC和IP之间存在一致的差异；角蛋白和上皮膜抗原在ISC中存在而在IP中不存在，而肌动蛋白仅在IP的增殖性梭形细胞中观察到。总之，ISC和IP之间潜在的临床病理重叠提示在区分这两种病变时应谨慎。特别是，在术中冰冻切片的情况下试图进行这种区分是不明智的。
