摘要
目的探讨肺肠型腺癌(pulmonary enteric adenocarcinoma,PEAC)患者的临床病理特征、治疗措施及预后。方法选取2019—2023年首都医科大学宣武医院PEAC患者8例。所有患者均通过病理诊断为PEAC,且排除结直肠腺癌。收集患者的临床表现、影像检查、病理检查、治疗方案及预后等资料,并进行文献复习。结果8例患者中,男性3例,女性5例,年龄50~79岁,中位年龄为67.5岁。最常见症状为咳嗽(62.5%),部分患者有气短、胸闷等表现。胸部CT结果显示,6例表现为软组织肿块影,1例为磨玻璃结节,1例为多发结节伴胸腔积液。病理切片镜下见高柱状肿瘤细胞构成腺样或筛状结构。免疫组化结果显示,8例患者CK-7均呈阳性表达,7例CDX-2阳性,5例CK-20阳性,5例Villin阳性,其中3例患者上述4种染色均阳性。基因检测提示表皮生长因子受体(epidermal growth factor receptor,EGFR)和Kirsten大鼠肉瘤病毒癌基因同源物(Kirsten rat sarcoma viral oncogene homolog,KRAS)基因突变阳性各1例。治疗方面,3例Ⅰ~Ⅱ期患者接受手术治疗,3例Ⅳ期患者接受化疗及免疫治疗,1例Ⅱ期接受靶向治疗。随访结果显示,PEAC患者的预后与临床分期及治疗方案相关,最长生存期为58个月。结论PEAC是肺腺癌的一种罕见亚型,其人口学特征和临床表现缺乏特异性,胸部CT常表现为较大的软组织团块影,需要结合病理及免疫组化进行确诊。早期诊断、综合治疗和免疫治疗可能延长患者的生存期。
Objective To explore the clinicopathological characteristics,treatment and prognosis of patients with pulmonary enteric adenocarcinoma(PEAC).Methods A total of eight patients with PEAC in Xuanwu Hospital,Capital Medical University,from 2019 to 2023 were selected.All patients were diagnosed as PEAC by pathology,with colorectal adenocarcinoma being excluded.Clinical manifestations,imaging findings,pathological examination,treatment regimens and prognostic data were collected and reviewed.Results Among the eight patients,there were three male and five female,aged from 50 to 79 years,with a median age of 67.5 years.The most common symptom was cough(62.5%),while some patients also exhibited shortness of breath and chest tightness.Chest CT showed that six cases presented as soft tissue masses,one as ground-glass nodule,and one with multiple nodules accompanied by pleural effusion.Histological examination showed highcolumnar tumor cells forming glanduar or sieve-like structures.Immunohistochemical results showed that CK-7 positive in all cases,CDX-2 positive in seven cases,CK-20 positive in five cases,and Villin positive in five cases,three patients were positive for all four stains mentioned above.Genetic testing showed that epidermal growth factor receptor gene mutation positivity in one case and Kirsten rat arcomaviral oncogene homolog gene mutation positivity in another.In terms of treatment,three patients with stage I-II underwent surgery,three patients with stage IV received chemotherapy and immunotherapy,and one patient with stage II was treated with targeted therapy.The follow-up data showed that the prognosis of PEAC patients was related to clinical stage and treatment regimen,with the longest survival being 58 months.Conclusions PEAC is a rare type of lung adenocarcinoma with clinicopathological features similar to those of colorectal adenocarcinoma.Chest CT often shows large soft tissue mass shadow,which needs to be diagnosed by combination of pathology and immunohistochemistry.Early diagnosis,comprehensive treatment and immunotherapy may prolong the survival time of patients.
作者
陈玉
王雅杰
聂秀红
Chen Yu;Wang Yajie;Nie Xiuhong(Department of Respiratory and Critical Care Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《北京医学》
2025年第4期273-278,共6页
Beijing Medical Journal
基金
2022年度北京市重大疫情防治重点专科建设项目。
关键词
肺肠型腺癌
临床病理特征
诊断
治疗
预后
pulmonary enteric adenocarcinoma(PEAC)
clinicopathological characteristics
diagnosis
treatment
prognosis
