摘要目的探讨间变性淋巴瘤激酶（ ALK）基因重排阳性肺腺癌的细胞病理学特点。方法回顾性分析2011年9月至2015年4月在复旦大学附属肿瘤医院用细胞学标本进行ALK基因重排和／或ALK融合蛋白检测的肺腺癌连续病例153例，包括胸水34例，经气管镜超声引导针吸活检术（ EBUS-TBNA）40例，体表肿块穿刺79例。结果经荧光原位杂交（ FISH）和免疫组织化学Ventana ALK（D5F3）证实的ALK阳性病例共39例（25.5％），其中单独由FISH法确定的3例，经两者共同证实的36例。中位年龄50岁，较ALK阴性者（60岁）年轻（ P＝0.002）。39例ALK阳性患者中只有4例为吸烟者，明显少于阴性组（ P＜0.01）。 ALK阳性病例中3例可见筛孔状结构和明显的核仁，3例见筛孔状结构和黏液细胞，8例见细胞外黏液和黏液细胞，出现率显著高于ALK阴性病例（均P＜0.01）。结论细胞学标本（常规涂片和细胞块）可以显示ALK阳性肺腺癌的一些形态学特征如筛孔状结构、明显的核仁、黏液细胞和细胞外黏液等，结合患者临床特征，对于筛选潜在ALK阳性的肺腺癌患者有一定帮助。

abstractsObjective To study the cytomorphologic features of anaplastic lymphoma kinase ( ALK )-rearranged pulmonary adenocarcinoma.Methods The morphologic features in 153 pulmonary adenocarcinoma cytology specimens encountered during the period from September, 2011 to April, 2015 in Shanghai Cancer Hospital were retrospectively reviewed.Fluorescence in-situ hybridization ( FISH) and/or immunohistochemistry ( Ventana D5F3) for ALK gene rearrangement were carried out.The samples studied included 34 pleural effusion specimens, 40 endobronchial ultrasound-guided transbronchial needle aspirates ( EBUS-TBNA) and 79 fine needle aspirates of palpable masses on body surface.Results Thirty-nine cases (25.5%) of ALK-rearranged samples were identified by FISH and/or immunohistochemistry, including 3 cases diagnosed by FISH and 36 cases by both technologies.The median age of the ALK-positive group was 50 years, significantly younger than that of the ALK-negative group (60 years old,P=0.002) .Only 4 of the ALK-positive patients were smokers, which was significantly less than that of the ALK-negative group (P<0.01).In ALK-positive group, 3 cases showed cribriform pattern with prominent nucleoli, 3 cases showed cribriform pattern with mucin-rich cells and 8 cases showed extracellular mucus with mucin-rich cells.The above cytomorphologic patterns were significantly less common in ALK-negative tumors ( P <0.01 ) . Conclusions ALK-rearranged lung adenocarcinoma is associated with certain distinctive morphologic patterns, including cribriform architecture, presence of prominent nucleoli, mucin-rich cells and extracellular mucus, which can be observed in cytology specimens ( including conventional smears and cell block sections) .These findings, when combined with clinical features, may give clues to detection of ALK-positive cases.