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目的探讨肺透明细胞类癌的临床病理特征、诊断与鉴别诊断要点、治疗及预后。方法对来自本院胸外科的1例肺透明细胞类癌青年男性患者的手术标本切片,进行组织形态学观察和免疫组织化学检测,并结合文献进行临床病理分析。结果患者因体检发现右下肺包块2年入院,切除标本见肿瘤位于右下肺边缘,为一边界清楚、质地中等的灰白色类圆形结节。镜下观察见均匀一致的肿瘤细胞呈片状或巢团状排列,细胞体积较大,细胞质透明,核圆居中。免疫组化显示肿瘤细胞CD56、Syn、CgA均为强阳性,CK、TTF-1阳性,Ki-67阳性细胞数<1%,S-100蛋白灶性阳性,Vimentin间质血管阳性,而HMB45、SMA、GFAP、Actin均为阴性。病理诊断:肺透明细胞类癌。行肺叶切除术后至今(6年)未见复发转移。结论肺透明细胞类癌是一种非常罕见的低度恶性肿瘤,仔细的大体检查、广泛取材和正确的免疫组化标记是诊断的关键;准确的病理组织学分型对治疗和预后评估有重要意义。
Objective To investigate the clinicopathological features, diagnosis and differential diagnosis, treatment and prognosis of lung clear cell carcinoid. Methods One case of young male patients with clear cell carcinoma of the lung from the department of thoracic surgery was sectioned and histomorphologically observed and immunohistochemically detected. The clinicopathological analysis was performed based on the literature. Results The patient was found to have been admitted to the right lower lung mass for 2 years because of physical examination. The tumor was located at the edge of the right lower lung for resection specimens and was a clear gray-white round nodule with a clear border. Microscopically observed uniform tumor cells showed flake or nest mass arrangement, larger cells, cytoplasm transparent, nuclear round center. Immunohistochemistry showed that CD56, Syn and CgA of tumor cells were strongly positive, CK and TTF-1 were positive, the number of Ki-67 positive cells was less than 1%, S-100 protein was positive and Vimentin was positive, while HMB45, SMA, GFAP, Actin were negative. Pathological diagnosis: lung clear cell carcinoid. Line lobectomy since (6 years) no recurrence and metastasis. Conclusions Lung clear cell carcinoid is a very rare low-grade malignant tumor. Careful general examination, widely taken and correct immunohistochemical staining are the key points in diagnosis. Accurate histopathological classification is of great significance for the treatment and prognosis evaluation .