Micropapillary-Predominant Invasive Adenocarcinoma with Aerogenous Spread-A Case Report

微乳突型侵襲性肺腺癌的氣行性散怖之病例報告

施慧瑄(Hui-Hsuan Shih) ； 龔昱中(Yu-Chung Kung) ； 曾岐元(Chi-Yuan Tzen) ； 彭明仁(Ming-Jen Peng)

《胸腔醫學》 28卷4期 (2013/08) Pp. 209-214

摘要

肺腺癌中微乳突型病理分類具有兩種成份：氣行性散佈或基質侵襲，其中氣行性散佈較基質侵襲性分類為多。氣行性散佈定義為肺泡空間中看到癌細胞漂浮在其中，而沒有基質的侵襲。這顯示癌細胞經由肺泡空間以細胞與細胞、細胞與基質之間的交互作用、嗜中性白血球中介之過程以及後續的訊息傳遞而導致的擴散。臨床上的表現是多發性的肺內擴散、癌細胞因脫落而可在氣道灌洗液中發現，以及在非癌肺組織中可看見發炎的現象。因此氣行性散佈的發現顯示較差的預後。我們提出一位T4N0M1a第四期肺腺癌的68歲女性，具有多發性的肺轉移。切除下來的組織病理顯示微乳突型侵襲性肺腺癌且具有氣行性散佈。而非癌肺組織中則顯示顯著的發炎及壞死現象。

關鍵字

氣行性散佈 ； 微乳突型成份 ； 侵襲性腺癌

並列摘要

Micropapillary components of lung adenocarcinoma are classified into 2 types, aerogenous and stromal invasive, based on their pattern of dissemination. Aerogenous spread is characterized by the presence of tumor cells floating within the alveolar spaces rather than invading the stroma, and is more frequently encountered than the stromal invasive type. This suggests that metastasis of tumor cells occurs via the alveolar spaces by intercellular and cell-matrix interactions, and involves a neutrophil-mediated process and subsequent signaling cascades. The clinical presentation includes multifocal intrapulmonary metastases, the shedding of tumor cells that are found in the bronchoalveolar lavage, and an inflammatory process in the non-neoplastic lung tissue. Aerogenous spread therefore indicates a rather poor prognosis. We presented a 68-year-old woman with T4N0M1a adenocarcinoma and multifocal intrapulmonary metastases. The pathological examination of resected tissue showed micropapillary-predominant invasive adenocarcinoma with an aerogenous spread within the alveolar space. The non-neoplastic lung tissue showed marked inflammation and necrosis.

並列關鍵字

aerogenous spread ； micropapillary components ； invasive adenocarcinoma