摘要目的 探讨伴微乳头结构的肺腺癌的临床病理学特征及免疫表型特点.方法 收集从北京协和医院2002年1月-2008年12月间135例手术切除肺腺癌中检出的48例伴有微乳头结构肺腺癌(微乳头的成分≥10%)临床资料.分析其临床病理特点,并用免疫组织化学EnVision法染色观察黏蛋白1(Muc-1)、上皮性钙黏蛋白(E-cadherin)、β-连接蛋白(β-catenin)、表皮生长因子受体(EGFR)、p53、Ki-67的表达.结果 48例伴微乳头结构的肺腺癌病例中,男性27例,女性21例,年龄43～85岁,平均年龄60.7岁.TNM分期Ⅰ期13例,Ⅱ期8例,Ⅲ期14例,Ⅳ期13例.48例中,36例均可见无血管轴心的微乳头漂浮在肺泡腔(ⅠA型)或纤维间隙中(Ⅰ B型),余12例腺癌结构类似细支气管肺泡癌样,但有微乳头向腔内突起,并有微乳头漂浮在衬覆肿瘤细胞的腔内(Ⅱ型).35例切除标本病理检查淋巴结转移率(72.9%),30例伴淋巴管瘤栓(62.5%),与不含微乳头成分的肺腺癌比较,二者差异有统计学意义(P<0.01).黏附分子E-cadherin和β-catenin、Muc-1、EGFR、p53及Ki-67的阳性率分别为97.9%(47/48)、89.5%(43/48)、91.7%(44/48)、70.8%(34/48)、35.4%(17/48)、93.8%(45/48);染色强度3+以上高表达病例分别占阳性表达的72.3%(34/47)、90.7%(39/43)、88.6%(39/44)、52.8%(19/36)、58.8%(10/17)、46.7%(21/45).36例患者获得随访信息,平均随访时间21.1个月,其中44.4%(16/36)患者术后生存至今,未见肿瘤发生,33.3%(12/36)患者死于肿瘤,22.2%(8/36)患者带瘤生存.结论 肺腺癌中微乳头结构与淋巴结转移及淋巴管瘤栓密切相关,提示其具有高度恶性的潜能及预后不良.

abstractsObjective To study the clinicopathologic characteristics and immunohistochemical profile of lung adenocarcinomas with a micropapillary pattern (MPP). Methods Among 135 cases of lung adenocarcinomas, the clinical, histological and immunohistochemical features of 48 cases of lung adenocarcinomas with a micropapillary components ( the micropapillary components ≥10% ) were studied. The literature was reviewed. Results All the 135 cases were resected pulmonary adenocareinomas. Among 48 cases of lung adenocarcinomas with a micropapillary components, the age of patients ranged from 43 to 85 years ( mean = 60. 7 years ). The male-to-female ratio was 9 : 7. Histologically, 36 cases of lung adenocarcinomas with the MPP were characterized by small papillary tufts lacking a central fibrovascular core lying freely within alveolar spaces (Ⅰ A type) or in the clefts of fibrous tissue just like those in MPP breast cancers (Ⅰ B type). Another type of the micropapillary pattern consisted of 12 cases, the micropapillary tufts floating within cystic spaces lined by tumor cells (Ⅱ type). In micropapillary pattern-positive cases, lymphatic invasion and lymph node metastasis were identified significantly more frequently than in micropapillary pattern-negative cases (P < 0. 01 ). The percentages of cases positive for various markers were 9 7.9 % ( 47/48 ) for E- cadherin, 8 9.5 % ( 43/48 ) for β - catenin, 91.7 % ( 44/48 ) for Muc - 1 , 70. 8 % (34/48) for epidermal growth factor receptor, 35.4% (17/48) for p53, 93.8% (45/48) for Ki-67. The percentages of cases with high expression (including 3 + or 4 + ) for these markers were 72. 3% (34/47) for E-cadherin, 90. 7% (39/43) for β-catenin, 88. 6% (39/44) for Muc-1, 52. 8% (19/36) for epidermal growth factor receptor, 58. 8% (10/17) for p53, 46. 7% (16/36) for Ki-67. Adequate clinical follow-up information was available for 36 patients. The mean follow-up time was 21.1 months. Among these, 16 of 36 patients (44.4%) were alive with no evidence of tumor, 12(33. 3% ) were died, and 8 (22. 2% ) were alive with tumor. Conclusion Lung adenocarcinomas with the MPP correlates positively with lymphatic invasion and lymph node metastasis, and are likely to have a potential for high malignancy, suggestting a poor prognosis.