Purpose To investigate the clinicopathological features,diagnosis and differential diagnosis,and genetic alteration of lung cribriform adenocarcinoma (LCA).Methods Clinicopathological features and immunophenotype were retrospectively evaluated in twenty LCA cases collected from Fujian Provincial Hospital,combined with genetic mutation analysis of EGFR.Results The tumors occurred in 5 women and 15 men aged from 39 to 74 years (median =59.25).Diameter of masses ranged from 1.5-5.5 cm (median =3.265).Histologically,the tumors were unencapsulated and were divided by fibrous septa into lobules.Major parts of the lesions were composed of areas with solid and microcystic growth patterns.The most striking cytological feature was that the tumor cell nuclei were pale staining with a ground glass feature,and they often appeared to overlap.Immunephenotypically,the tumor cells were positive for TTF-1(20/20),Napsin A (18/20),SPB(19/20),CK7(20/20),CD56 (2/20),EGFR (7/20),β-catenin (4/20),ALK (2/20).Tg,CDX-2,Syn,CgA,S-100 and SMA were negative.Gene mutation detection confirmed that EGFR genes were mutating in nine cases,and eleven cases were wild type.The twenty cases were all performed for the completely surgical resection.20 cases accepted chemotherapy,and 4 cases unaccepted chemotherapy.Conclusion LCA is a rare tumor with distinct morphologic feature.Clinically and pathologically,it needs to differentiate from alveolus adenocarcinoma,adenoid cystic carcinoma and papillary carcinoma of the thyroid,and so on.The primary treatment for LCA is completely surgical excision and chemotherapy.Otherwise its prognosis is poor.%目的 探讨肺筛状腺癌(lung cribriform adenocarcinoma,LCA)的临床病理学特征、诊断、鉴别诊断及分子遗传学特点.方法对20例LCA进行组织学形态观察、免疫组化及特殊染色检查、随访并复习相关文献.结果 女性5例,男性15例,年龄39～74岁(中位年龄59.25),肿块直径1.5 ～5.5 cm(平均直径3.265 cm).镜下肿瘤呈分叶状或结节状,肿瘤细胞较一致,呈筛状排列,腺样,微囊样,实性,其中筛状结构特征明显,核分裂象较少,未见坏死.免疫表型:肿瘤细胞TTF-1(20/20)、Napsin A(18/20)、SPB(19/20)、CK7(20/20)、CD56(2/20)、EGFR(7/20)、β-catenin(4/20)和ALK(2/20)均阳性,Tg、CDX-2、Syn、CgA、S-100和SMA均阴性.9例(9/20)检测到EGFR基因突变信号.20例均行手术切除,术后16例(16/20)行化疗,2例放疗,4例未治疗.结论 LCA属罕见的肺癌,具有特征性的病理学表现,临床及病理均需与腺泡型腺癌、腺样囊性癌、神经内分泌癌、转移性甲状腺乳头状癌等肿瘤相鉴别,治疗以手术切除及化疗为主,预后较差.
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