肺肝樣腺癌臨床特征分析并文獻(xiàn)復(fù)習(xí)（附2例報(bào)道）
發(fā)布時(shí)間：2019-03-16 14:26
【摘要】：目的:探討肺肝樣腺癌(hepatoid adenocarcinoma of lung,HAL)的臨床病理特點(diǎn),提高臨床認(rèn)識(shí),減少漏診、誤診。方法:回顧性分析我院2例肺肝樣腺癌患者臨床表現(xiàn)、實(shí)驗(yàn)室檢查、影像學(xué)及病理學(xué)資料,并復(fù)習(xí)相關(guān)文獻(xiàn),探討HAL的臨床特點(diǎn)。結(jié)果:(1)病例一為50歲男性,既往長期吸煙史,無肝臟疾病史,主要癥狀為咳嗽、聲嘶、胸痛。血清AFP、肝功能未見異常。肺部CT示左肺上葉塊狀影,支氣管鏡支刷物涂片可見癌細(xì)胞,經(jīng)皮肺穿刺活檢病理診斷肺肝樣腺癌,AFP表達(dá)陰性。肝臟CT、B超檢查等未見異常。患者未行化療,出院后隨訪4個(gè)月死亡。病例二為58歲男性,既往長期吸煙史,無肝臟疾病史,主要癥狀為咳嗽、咳痰、胸痛。血清AFP、肝功能正常。肺部CT示左肺下葉大片密度增高影,PET/CT顯示代謝增高,病灶肺組織病理示肺肝樣腺癌,APF表達(dá)陽性。肝臟CT、B超檢查等未見異常�；颊呶葱谢�,出院后隨訪1年半仍存活。(2)文獻(xiàn)復(fù)習(xí)結(jié)果:從Pubmed等數(shù)據(jù)庫檢索從1990年至2016年12月國內(nèi)外肺肝樣腺癌病例報(bào)道文獻(xiàn),檢索到40篇文獻(xiàn),病理結(jié)果符合肺肝樣腺癌,其中男性發(fā)病92.5%(37/40),平均發(fā)病年齡59.4歲,病變好發(fā)于上葉(31/40),納入癥狀統(tǒng)計(jì)29例,24.1%無癥狀(7/29),75.8%有癥狀(22/29),主要呼吸道癥狀為咳嗽(13/29)、咳痰(5/29)、咯血(5/29)、呼吸困難(5/29)。共26例行影像學(xué)檢查表現(xiàn)均為單發(fā)結(jié)節(jié)影(26/26),呈類圓形或分葉狀,部分有毛刺,靠近肺門及貼近胸壁。多數(shù)患者血清AFP增高及免疫組化AFP表達(dá)陽性。組織病理類似肝細(xì)胞癌,由肝樣分化區(qū)和腺癌區(qū)組成。治療方法包括手術(shù)、化療、放療。結(jié)論:1.HAL臨床少見,多為中老年發(fā)病,呈男性發(fā)病優(yōu)勢(shì),常有吸煙史,無肝臟疾病史。2.HAL主要呼吸道癥狀為咳嗽、咳痰、咯血,部分無癥狀;好發(fā)于肺上葉,表現(xiàn)為直徑較大單結(jié)節(jié),病灶可強(qiáng)化,PET/CT顯示高代謝影。3確診以病灶肺組織病理具有肝細(xì)胞癌形態(tài)特征為依據(jù),需排除肝癌肺轉(zhuǎn)移。4.HAL癌細(xì)胞AFP表達(dá)多為陽性,血清AFP水平可增高。
[Abstract]:Objective: to investigate the clinicopathological features of lung hepatoid adenocarcinoma (hepatoid adenocarcinoma of lung,HAL) in order to improve clinical understanding and reduce missed diagnosis and misdiagnosis. Methods: the clinical manifestations, laboratory examination, imaging and pathological data of 2 patients with lung hepatoid adenocarcinoma in our hospital were analyzed retrospectively. The clinical features of HAL were also reviewed. Results: (1) A 50-year-old male had a long history of smoking and no history of liver disease. The main symptoms were cough, hoarseness and chest pain. The liver function of serum AFP, was not abnormal. Lung CT showed a mass shadow of the upper lobe of the left lung. Cancer cells could be seen on bronchoscope brushing smears. AFP expression was negative in liver-like adenocarcinoma of the lung diagnosed by percutaneous lung biopsy. No abnormality was found in CT, examination of liver. The patient did not receive chemotherapy and died after 4 months of follow-up. Case 2 is 58-year-old male, long-term smoking history, no history of liver disease, the main symptoms are cough, expectoration, chest pain. The liver function of serum AFP, was normal. Pulmonary CT showed high density in left inferior lobe, increased metabolism in PET/CT, and positive expression of APF in liver-like adenocarcinoma of lung. No abnormality was found in CT, examination of liver. The patients were followed up for one and a half years after discharge without chemotherapy. (2) the results of literature review: from Pubmed and other databases, 40 articles were retrieved from domestic and foreign reports of lung liver-like adenocarcinoma cases from 1990 to 2016. The pathological results were consistent with that of liver-like adenocarcinoma of the lung, in which 92.5% (37 / 40) were male, the average age of onset was 59.4 years old, the lesion was most common in the upper lobe (31 / 40), and 29 cases (24.1%) were asymptomatic (7 / 29). The main respiratory symptoms were cough (13 / 29), expectoration (5 / 29), hemoptysis (5 / 29) and dyspnea (5 / 29). The imaging findings of 26 cases were single nodular (26 / 26), round or lobulated, with partial burr, close to the hilum and close to the chest wall. Most of the patients had elevated serum AFP and positive expression of immunohistochemical AFP. Histopathology is similar to hepatocellular carcinoma (HCC) and consists of liver-like differentiation and adenocarcinomas. Treatments include surgery, chemotherapy, and radiotherapy. Conclusion: the main respiratory symptoms of 1.HAL are cough, expectoration, hemoptysis, and some of them are asymptomatic, usually have smoking history and have no history of liver disease, the main respiratory symptoms of HAL are cough, expectoration, hemoptysis and so on. Most of the lesions occurred in the upper lobe of the lung, showing a large single nodule in diameter, and the lesions could be enhanced, and PET/CT showed high metabolic shadows. 3 the diagnosis was based on the pathological features of hepatocellular carcinoma in the lung tissue of the lesion, and the diagnosis was based on the pathological features of HCC. 4. The expression of AFP in HAL cancer cells was positive, and the serum AFP level could be increased.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2
本文編號(hào)：2441549
[Abstract]:Objective: to investigate the clinicopathological features of lung hepatoid adenocarcinoma (hepatoid adenocarcinoma of lung,HAL) in order to improve clinical understanding and reduce missed diagnosis and misdiagnosis. Methods: the clinical manifestations, laboratory examination, imaging and pathological data of 2 patients with lung hepatoid adenocarcinoma in our hospital were analyzed retrospectively. The clinical features of HAL were also reviewed. Results: (1) A 50-year-old male had a long history of smoking and no history of liver disease. The main symptoms were cough, hoarseness and chest pain. The liver function of serum AFP, was not abnormal. Lung CT showed a mass shadow of the upper lobe of the left lung. Cancer cells could be seen on bronchoscope brushing smears. AFP expression was negative in liver-like adenocarcinoma of the lung diagnosed by percutaneous lung biopsy. No abnormality was found in CT, examination of liver. The patient did not receive chemotherapy and died after 4 months of follow-up. Case 2 is 58-year-old male, long-term smoking history, no history of liver disease, the main symptoms are cough, expectoration, chest pain. The liver function of serum AFP, was normal. Pulmonary CT showed high density in left inferior lobe, increased metabolism in PET/CT, and positive expression of APF in liver-like adenocarcinoma of lung. No abnormality was found in CT, examination of liver. The patients were followed up for one and a half years after discharge without chemotherapy. (2) the results of literature review: from Pubmed and other databases, 40 articles were retrieved from domestic and foreign reports of lung liver-like adenocarcinoma cases from 1990 to 2016. The pathological results were consistent with that of liver-like adenocarcinoma of the lung, in which 92.5% (37 / 40) were male, the average age of onset was 59.4 years old, the lesion was most common in the upper lobe (31 / 40), and 29 cases (24.1%) were asymptomatic (7 / 29). The main respiratory symptoms were cough (13 / 29), expectoration (5 / 29), hemoptysis (5 / 29) and dyspnea (5 / 29). The imaging findings of 26 cases were single nodular (26 / 26), round or lobulated, with partial burr, close to the hilum and close to the chest wall. Most of the patients had elevated serum AFP and positive expression of immunohistochemical AFP. Histopathology is similar to hepatocellular carcinoma (HCC) and consists of liver-like differentiation and adenocarcinomas. Treatments include surgery, chemotherapy, and radiotherapy. Conclusion: the main respiratory symptoms of 1.HAL are cough, expectoration, hemoptysis, and some of them are asymptomatic, usually have smoking history and have no history of liver disease, the main respiratory symptoms of HAL are cough, expectoration, hemoptysis and so on. Most of the lesions occurred in the upper lobe of the lung, showing a large single nodule in diameter, and the lesions could be enhanced, and PET/CT showed high metabolic shadows. 3 the diagnosis was based on the pathological features of hepatocellular carcinoma in the lung tissue of the lesion, and the diagnosis was based on the pathological features of HCC. 4. The expression of AFP in HAL cancer cells was positive, and the serum AFP level could be increased.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 Jiann-Sheng Su;Yu-Tso Chen;Ren-Ching Wang;Chun-Ying Wu;Shou-Wu Lee;Teng-Yu Lee;;Clinicopathological characteristics in the differential diagnosis of hepatoid adenocarcinoma:A literature review[J];World Journal of Gastroenterology;2013年03期
2 白辰光;劉曉紅;余永偉;張順民;馬大烈;;肺肝樣腺癌1例及文獻(xiàn)復(fù)習(xí)[J];臨床與實(shí)驗(yàn)病理學(xué)雜志;2006年02期
，本文編號(hào)：2441549
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