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肺肝样分化腺癌(hepatoid adenocarcinoma of the lung,HAL)是指肿瘤细胞具有肝细胞样分化、有类似肝细胞癌的形态特征、免疫组化甲胎蛋白(α-fetoprotein,AFP)表达呈阳性并且原发于肺部的腺癌[1]。HAL恶性程度高、侵袭性强、预后较普通型腺癌差,5年生存率约为55%[2]。此病临床罕见,多为个案报道,少有文献报道PET/CT显像的病例。我们对1例HAL患者的临床资料进行分析,结合文献总结其影像学特征,以提高医师对该病的认识。
肺肝样分化腺癌18F-FDG PET/CT显像一例
18F-FDG PET/CT imaging of hepatoid adenocarcinoma of the lung: a case report
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摘要: 笔者报道了1例肺肝样分化腺癌(HAL)患者的18F-氟脱氧葡萄糖(FDG) PET/CT 显像,分别从临床症状、实验室检查、术前增强CT显像、手术所见及18F-FDG PET/CT显像等方面分析了该病的特点,并通过文献回顾总结了HAL的组织病理学及影像学特征。HAL在临床上较为罕见,多为个案报道,目前少有文献报道HAL18F-FDG PET/CT显像的病例。Abstract: The author reported a case of hepatoid adenocarcinoma of the lung (HAL) with 18F-fluorodeoxyglucose (FDG) PET/CT imaging, which was analyzed from clinical symptoms, laboratory examinations, preoperative contrast-enhanced CT imaging, surgical findings, and 18F-FDG PET/CT imaging. The pathological and imaging characteristics of HAL were summarized through literature review. Cases of HAL is clinically rare, and most of them are case reports. There are few case reports of 18F-FDG PET/CT imaging.
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图 1 肺肝样分化腺癌患者(男性,66岁)的胸部CT平扫和增强扫描图 A、B、C分别为CT平扫、增强CT动脉期、增强CT静脉期图。CT平扫显示右肺上叶尖后段可见大小约4.1 cm×3.5 cm×4.0 cm的不规则软组织肿块影,边界清晰,内部密度不均匀,近肺门侧见斑片状稍高密度影;增强CT动脉期、静脉期病变明显且持续强化,远端片状低密度区未见明显强化。CT为计算机体层摄影术
Figure 1. Chest CT and contrast-enhanced CT images of a patient with hepatoid adenocarcinoma of the lung(male, 66 years old)
图 2 肺肝样分化腺癌患者(男性,66岁)的18F-FDG PET/CT显像图 A为最大密度投影图,示身体除病灶外的部位未见异常放射性核素浓聚灶;B、C分别为横断面和冠状面的CT、PET、PET/CT图,示右肺上叶不规则肿块,密度不均,实性部分靠近肺门侧,放射性核素摄取明显增高,SUVmax=14.2,远端低密度区放射性核素分布缺损。FDG为氟脱氧葡萄糖;PET为正电子发射断层显像术;CT为计算机体层摄影术;SUVmax为最大标准化摄取值
Figure 2. 18F-FDG PET/CT images of a patient with hepatoid adenocarcinoma of the lung(male, 66 years old)
图 3 肺肝样分化腺癌患者(男性,66岁)的术后组织病理学检查(A)和免疫组织化学染色图(B~D) A为肺肝样分化腺癌患者的组织病理学检查图(苏木精-伊红染色,×200),显示癌细胞排列成团片状、异型显著;B~D分别为肺肝样分化腺癌患者的Glypican-3、Hep Par1、TTF1免疫组织化学染色图(×200),显示Glypican-3、Hep Par1表达呈阳性,TTF1表达呈阴性,符合肺肝样分化腺癌的特征。Glypican-3表达于胚胎性肝及胎盘组织的合体滋养叶细胞层中,一般用于鉴别肝细胞癌和肝脏良性增生结节。Hep Par1为肝癌细胞特异性标记;TTF1为甲状腺转录因子1
Figure 3. Postoperative pathological pictures and immunohistochemical staining of a patient with hepatoid adenocarcinoma of the lung(male, 66 years old)
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