Abstract
Lung adenocarcinoma is characterized by marked heterogeneity and may be composed of an admixture of histologic growth patterns, including acinar, papillary, solid, and lepidic (bronchioloalveolar). Tumors displaying a prominent or predominant cribriform architecture are rare and most often confused for metastases from other organs. We report the clinical, histologic, immunohistochemical, and molecular features in 15 primary lung adenocarcinomas with a predominant cribriform histology. All patients were adults between 30 and 80 years of age (median: 64), and all but one reported a history of heavy cigarette smoking. All cases showed a predominant (>70%) cribriform architecture that resembled a variety of tumors arising in other organs, including breast, prostate, ovary, pancreas, uterus, colon, and thyroid. Immunohistochemical stains showed a phenotype consistent with a primary lung tumor (ie, TTF1+/CK7+), with negative results for other markers. Molecular analysis in six cases showed that none harbored an EGFR-activating mutation. KRAS mutation was detected in one case, and an ALK1 and ROS1 gene rearrangement were each detected in an additional two cases. Cribriform adenocarcinomas of the lung represent a distinctive histologic subtype of lung cancer that may be morphologically difficult to differentiate from metastases with a predominant cribriform architecture.
摘要
肺腺癌的特点是有明显的异质性,可有多种组织学形态,如腺泡状、乳头状、实性和贴壁生长(细支气管肺泡癌)。以筛状结构为主的肿瘤罕见,常和其他器官的转移相混淆。我们报告了15例以筛状生长方式为主的原发性肺腺癌的临床、组织学、免疫组织化学和分子生物学特点。
材料与方法:患者均为成人,30-80岁(中位年龄64岁),除了一位以外均有重度吸烟史。
结果:全部病例以筛状生长方式为主(>70%),筛状结构与其他器官起源的肿瘤类似,如乳腺、前列腺、卵巢、胰腺、子宫、结肠和甲状腺。免疫组织化学染色与原发性肺腺癌一致(如:TTF1+/CK7+),其他的标记物阴性。分子生物学分析表明6例无EGFR活性突变。1例有KRAS突变,另有ROS1和ALK基因重排分别检出两例。
结论:肺筛状腺癌代表了一种独特的肺腺癌组织学亚型,形态学上难以与转移性筛状结构为主的腺癌区别。
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