- 期刊
Clear Cell Variant Squamous Cell Carcinoma of the Lung-A Case Report
透明細胞型鱗狀上皮細胞癌－病例報告
摘要
在肺癌中透明細胞(clear cell)的分化並不少但幾乎由透明細胞所構成的肺癌相當罕見，透明細胞在顯微鏡下的病理表現為水樣透明的細胞質。由透明細胞構成的肺部腫瘤需要鑑別診斷的包括良性透明細胞瘤、原發或次發透明細胞癌、以及透明細胞型鱗狀上皮細胞癌或腺癌作鑑別診斷，因為預後截然不同。仔細的病理切片檢查，免疫化學染色和詳盡的泌尿系統檢查都是必須的。但在此我們提出一個屬於第一期的透明細胞型鱗狀上皮細胞癌病例，臨床症狀只有咳嗽，胸部X光片為左上肺葉一週邊腫瘤，而電腦斷層攝影下其密度為似囊狀病變，並無縱隔腔淋巴結腫大或遠處轉移。經根除性左上肺葉切除術後其病程進展及局部轉移相當快速。在此並回顧歷年來與此病例相關的文獻報告。
關鍵字
透明細胞型鱗狀上皮細胞癌並列摘要
Clear cell change in primary lung cancer is not uncommon, but clear cell-predominant bronchogenic carcinoma is extremely rare. The unique pathologic character of clear cells is large polygonal tumor cells with ”water-clear” or foamy cytoplasm. Most of the reports had a favorable prognosis. A 72-year-old male was seen with persistent dry cough; chest radiography revealed a left upper lobe mass. After a detailed survey, left upper lobe lobectomy and lymph node dissection were performed. Clear cell changes were found on nearly all pathologic sections and only few tiny squamoid differentiations were found. Clear cell variant of squamous cell carcinoma was the final diagnosis. The patient had an early local recurrence and chest wall metastasis after 6 months which was a quite unusual clinical course. The presentation of majority clear cells of lung cancer required a complete review of all pathologic sections to find any squamous or glandular differentiation. Benign sugar tumors and metastasis from urinary tract malignancy should also be differentiated both by immunohistochemical stains and detailed radiographic survey.