EGFR-Mutated Pulmonary Choriocarcinoma Combined With Adenocarcinoma
EGFR-Mutated Pulmonary Choriocarcinoma Combined With Adenocarcinoma
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EGFR 突变肺绒毛膜癌合并腺癌
DOI：
10.1016/j.jtho.2022.07.1146
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发表时间：
2022
影响因子：
20.4
通讯作者：
Inamura Kentaro
中科院分区：
文献类型：
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作者：
Shigematsu Yasuyuki;Nakano Kaoru;Uchibori Ken;Inamura Kentaro
一名78岁无吸烟史的女性以湿咳和用力性呼吸困难就诊于我院，1周内病情逐渐加重。体格检查结果显示胸腔右侧空气进入减少。ct示右肺中下叶一8.6 cm大小肿块，双叶多发结节（图1）。随后，在肝脏、椎骨和子宫内发现多发肿块。患者一般情况不佳，无法进行病理检查，于就诊后11天死亡。尸检结果显示最大的肿瘤块位于右肺中下叶，有“黑色”和“白色”成分，弥漫性肺泡损伤为直接死亡原因。病理检查结果进一步显示，“黑色”和“白色”区域分别代表绒毛膜癌和腺癌（图2）。镜下，绒毛膜癌成分由单核和多核滋养细胞组成，并表现出明显的出血，这是绒毛膜癌的特征，导致肉眼呈“黑色”外观。免疫染色结果显示，该肿瘤成分对生殖细胞标志物SALL4和人绒毛膜促性腺激素（hCG）呈阳性，而对肺细胞标志物TTF-1（也称为NKX2-1）和Napsin A呈阴性。相比之下，肿瘤的腺癌成分呈乳头状形态，免疫染色对TTF-1和Napsin A呈阳性，而对SALL4和hCG呈阴性。“黑色”绒毛膜癌已全身转移，导致双侧肺、肝脏、椎骨和子宫形成恶性病灶，而“白色”腺癌则局限于肺和纵隔淋巴结。这两个具有明显“黑色”和“白色”表型的成分的空间定位提出了肿瘤是起源于不同克隆的碰撞癌还是起源于同一克隆的单个癌的问题。
A 78-year-old woman with no history of smoking presented to our hospital with complaints of wet cough and exertional dyspnea that had worsened progressively in 1 week. Physical examination result revealed reduced air entry into the right side of the chest. Imaging result by computed tomography revealed an 8.6 cm-sized mass in the right middle-to-lower lobes and multiple nodules in the bilateral lobes of the lung (Fig. 1). Subsequently, multiple masses in the liver, vertebrae, and uterus were detected. The patient could not undergo a pathologic examination owing to poor general condition and died 11 days after presentation. Autopsy result revealed the largest tumor mass, which occupied the right middle-to-lower lobes of the lung, to have “black” and “white” components, and diffuse alveolar injury was identified as the direct cause of death. Pathologic examination result further revealed that the “black” and “white” areas represented choriocarcinoma and adenocarcinoma, respectively (Fig. 2). Microscopically, the choriocarcinoma component was composed of mononucleated and multinucleated trophoblastic cells and exhibited marked hemorrhage, which is characteristic of choriocarcinoma and caused the “black” macroscopic appearance. Immunostaining result revealed that this tumor component was positive for germ cell markers SALL4 and human chorionic gonadotropin (hCG) but negative for pneumocyte markers TTF-1 (also known as NKX2-1) and Napsin A. In contrast, the adenocarcinoma component of the tumor exhibited papillary morphology and immunostained positive for TTF-1 and Napsin A but not for SALL4 or hCG. The “black” choriocarcinoma had metastasized throughout the body, resulting in the formation of malignant foci in the bilateral lungs, liver, vertebrae, and uterus, whereas the “white” adenocarcinoma was localized within the lung and mediastinal lymph node. The spatial localization of the two components with distinct “black” and “white” phenotypes raised the question of whether the tumor was a collision carcinoma originating from different clones or a single carcinoma originating from an identical clone.