Double Primary Pulmonary Adenocarcinomas with Different Morphological Subtypes and Different Anaplastic Lymphoma Kinase Expression in a 47-Year- Old Never-Smoking Woman - A Case Report

雙重原發性肺腺癌呈現不同之組織型態表現及不同間變性淋巴瘤激酶表現在一位47歲的非吸菸女性－案例報告

潘奕宏(Yi-Hung Pan) ； 楊志仁(Chih-Jen Yang) ； 李瑞英(Jui-Ying Lee) ； 林智鴻(Chih-Hung Lin) ； 黃明賢(Ming-Shyan Huang)

《胸腔醫學》 33卷6期 (2018/12) Pp. 242-248

摘要

Multiple primary lung cancer (MPLC) is a potentially curable malignancy. It is difficult to diagnose accurately, since the diagnosis depends on a histologic presentation of lung cancer, especially when these intrapulmonary nodules share the same histologic type or similar subtypes. Molecular diagnosis, such as epidermal growth factor gene mutation status, has been reported to enhance the diagnosis of MPLC. Since anaplastic lymphoma kinase (ALK) gene rearrangement is also a critical target in non-small cell lung cancer, it might be a potential tool in aiding the MPLC diagnosis. Here, we reported a 47-year-old never-smoking woman who had 2 peripheral pulmonary nodules of similar size at her right lower lobe and left upper lobe. The patient underwent a bilateral video-assisted thoracic surgery wedge resection, and pathologic diagnosis showed the 2 nodules were adenocarcinomas, but with different pathologic morphological features. Different ALK gene rearrangement expression types were found using ALK immunohistochemical staining, and further confirmed through use of the fluorescence in situ hybridization method. The 2 nodules were diagnosed finally as a double primary stage I lung cancer instead of an intrapulmonary metastasis of a primary lung cancer. This is the first case report of a possible role for ALK expression in the diagnosis of MPLC. We share this rare case and present a literature review.

關鍵字

multiple primary lung cancer ； ALK (anaplastic lymphoma kinase)

並列摘要

雖然肺癌的預後仍然相當差，而多發性原發肺癌是有機會能治癒的，但臨床上往往難僅由肺癌之形態組織學來做出準確診斷，尤其是肺內腫瘤擁有相同的組織型或相似的組織亞型時。分子病理診斷，如表皮生長因子受體突變（EGFR mutation）狀況曾被報告過用以協助多發性原發性肺癌之診斷。鑑於間變性淋巴瘤激酶重組（ALK rearrangement）型態在非小細胞肺癌中亦是重要的治療標的，或許它也是潛在能協助多發性肺癌診斷的工具。在此我們報告一位47歲非吸菸女性有兩顆大小相似之週邊肺結節，一在右下肺而另一在左上肺。這位女性接受雙側胸腔內視鏡輔助切除術。病理檢查呈現此兩個腫瘤皆為肺腺癌但有不同之病理形態表現。有趣的是，免疫化學染色法下的間變性淋巴瘤激酶型態表現完全不同，且此結果也透過螢光原位雜交法（FISH）來驗證。最終此兩個腫瘤被診斷為雙重原發性肺癌，而非轉移性肺癌。迄今為止，尚未有文獻報告利用間變性淋巴瘤激酶之表現做為多發性原發性肺癌的診斷工具。我們在此分享此一案例並進行文獻回顧。

並列關鍵字

多發性肺癌 ； 間變性淋巴瘤激酶