摘要目的：寻找表皮生长因子受体（EGFR）基因突变的肺腺癌的组织学特征。方法按照2011年国际肺癌研究学会、美国胸科学会和欧洲呼吸学会发布的肺腺癌国际多学科新分类的标准，对72例手术切除肺腺癌标本进行组织结构分类。同时还按照肺腺癌细胞形态的特点进行分类。分析不同类别与EGFR基因的突变的关系。结果72例肺腺癌患者突变率为35／72（48．6％）。突变类型以19del和L858R为主，两者合计共占总突变例数的88．6％（31／35）。 EGFR基因突变与女性、不吸烟和高－中分化有关，而与年龄、吸烟指数、淋巴结转移、分期、有无包涵体及沙砾体和核分裂数高低无关。新分类还显示EGFR基因突变多见于乳头为主型和腺泡为主型肺腺癌，少见于实体为主伴黏液型，几乎不见于特殊类型肺腺癌（主要为浸润性黏液癌和胶样癌）。此外，EGFR基因突变还多见于鞋钉状细胞的肺腺癌中。结论乳头为主型、腺泡为主型和鞋钉状细胞的肺腺癌具有较高的EGFR基因突变率。

abstractsObjective To correlate morphological features with mutations of epidermal growth factor receptor ( EGFR) in lung adenocarcinomas.Methods According to 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Lung Adenocarcinoma Classification, a total of 72 surgically resected lung adenocarcinomas were collected and classified into different histological subtypes and different cell types ( hobnail, columnar and polygonal ) . EGFR gene mutation was detected with the amplification refractory mutation method provided by the EGFR mutation test kit.The correlation between these subtypes and EGFR mutations were evaluated.Results Mutations of EGFR were detected in 48.6%(35/72) of lung adenocarcinomas;19del and L858R were major mutational types (88.6%,31/35).EGFR mutations were associated with female gender, non-smoking status, and well to moderately differentiated tumor histology.EGFR mutation types were not associated with age, smoking index, lymph node metastasis, stage, status of whether have or not have inclusion bodies or psammoma bodies and mitotic level.Correlations were observed between acinar and papillary adenocarcinoma subtypes and EGFR mutations according to the new classification.EGFR mutation was rare in the subtype of solid adenocarcinoma with mucin production and almost never observed in special subtypes (mainly mucinous and colloid adenocarcinoma).In addition, EGFR mutation was associated with the hobnail cell type.Conclusion Lung adenocarcinomas of predominate acinar and papillary histological subtypes with hobnail cell morphology are good predictors for EGFR mutations.