Pulmonary carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements - A clinicopathologic and immunohistochemical study of 75 cases
Pulmonary carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements - A clinicopathologic and immunohistochemical study of 75 cases
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DOI：
10.1097/00000478-200303000-00004
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发表时间：
2003-03-01
影响因子：
5.6
通讯作者：
Brambilla, E
中科院分区：
文献类型：
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作者：
Rossi, G;Cavazza, A;Brambilla, E
我们收集了75例具有多形性、肉瘤样或肉瘤成分的原发性肺癌，以更好地确定其临床、组织学和免疫组化特征。患者的年龄范围为42至81岁（平均65岁），男女比例为9.7：1。69例患者（92%）为吸烟者。咳嗽、咯血是最常见的临床症状。59例患者（65%）死于疾病：仅分期显著预测总生存期（p = 0.0273）。显微镜下，根据WHO标准，58例被分类为多形性癌（51例为上皮成分，7例仅由梭形和巨细胞组成），10例为梭形细胞癌，3例为巨细胞癌，3例为癌肉瘤，1例为肺母细胞瘤。免疫组化，在肿瘤组成的梭形和/或巨细胞，甲状腺转录因子-1（TTF-1）和细胞角蛋白7阳性的情况下，分别为55%和70%，而表面活性蛋白-A总是阴性。在多形性癌的上皮成分，细胞角蛋白7，TTF-1和表面活性蛋白-A阳性的肉瘤样成分的情况下，分别为62.7%，43.1%和5.9%，而他们总是阴性的肉瘤部分的癌细胞瘤和母细胞瘤。在多形性癌的上皮成分中，细胞角蛋白7、TTF-1和表面活性蛋白-A的阳性率分别为76.4%、58.8%和39.2%，而癌性肉瘤的上皮成分则不与这些抗体反应;在母细胞瘤的情况下，肿瘤的上皮部分对细胞角蛋白7和TTF-1呈阳性，而对表面活性蛋白-A呈阴性。细胞角蛋白20始终为阴性。我们认为，本研究：1）支持这组肿瘤的化生组织发生理论; 2）表明细胞角蛋白7和TTF-1，而不是表面活性蛋白-A，是有用的免疫组化标记物在这种情况下; 3）证实分期是目前唯一重要的预后参数，如在传统的非小细胞肺癌;和4）表明在手术可治愈的I期，这组肿瘤比常规的非小细胞肺癌具有更差的预后，证明了它们在WHO分类中作为独立的组织学类型的分离。
We collected 75 primary pulmonary carcinomas with pleomorphic, sarcomatoid, or sarcomatous elements to better define their clinical, histologic, and immunohistochemical profile. The patient's age ranged from 42 to 81 years (mean 65 years), and the male-to-female ratio was 9.7:1. Sixty-nine patients (92%) were smokers. Cough and hemoptysis were the most frequent presenting symptoms. Fifty-nine patients (65%) died of disease: only stage significantly predicts overall survival (p = 0.0273). Microscopically, based on the WHO criteria, 58 cases were classified as pleomorphic carcinoma (51 with an epithelial component, 7 composed exclusively of spindle and giant cells), 10 as spindle cell carcinoma, 3 as giant cell carcinoma, 3 as carcinosarcoma, and 1 as pulmonary blastoma. Immunohistochemically, in the tumors composed exclusively of spindle and/or giant cells, thyroid transcription factor-1 (TTF-1) and cytokeratin 7 were positive in 55% and 70% of the cases, respectively, whereas surfactant protein-A was always negative. In pleomorphic carcinomas with an epithelial component, cytokeratin 7, TTF-1, and surfactant protein-A were positive in the sarcomatoid component in 62.7%, 43.1%, and 5.9% of the cases, respectively, whereas they were always negative in the sarcomatous part of carcinosarcomas and blastoma. In the epithelial component of pleomorphic carcinomas, cytokeratin 7, TTF-1, and surfactant protein-A were positive in 76.4%, 58.8%, and 39.2% of the cases, respectively, whereas the same antibodies did not react with the epithelial component of carcinosarcomas; in the case of blastoma, the epithelial part of the tumor was positive for cytokeratin 7 and TTF-1, whereas it was negative for surfactant protein-A. Cytokeratin 20 was always negative. In our opinion, this study: 1) supports the metaplastic histogenetic theory for this group of tumors; 2) shows that cytokeratin 7 and TTF-1, but not surfactant protein-A, are useful immunohistochemical markers in this setting; 3) confirms that stage is at the moment the only significant prognostic parameter, as in conventional non-small cell lung carcinomas; and 4) shows that this group of tumors has a worse prognosis than conventional non-small cell lung carcinoma at surgically curable stages I, justifying their segregation as an independent histologic type in the WHO classification.