摘要
神經內分泌肺腫瘤中大家較為熟悉的是小細胞肺癌(SCLC, small cell lung carcinoma)。自1999年的WHO肺癌(lung cancer)分類已經將大細胞神經內分泌肺癌(LCNEC, large cell neuroendocrine carcinoma)視為獨立之臨床病理分類。LCNEC和小細胞肺癌(SCLC)兩者都屬於分化極差的神經內分泌型肺癌。但是LCNEC在臨床症狀、影像和周邊部位雖然都和非小細胞肺癌(non-small cell lung carcinoma, NSCLC)群體相似。因為LCNEC預後較NSCLC更差，在治療上LCNEC必須與SCLC一樣積極；文獻已證實LCNEC縱使在早期也要積極化療才能延長壽命，因此病理診斷區分LCNEC對於治療至為重要。肺部尚有典型類癌(typical carcinoid, TC)和非典型類癌(atypical carcinoid, AC)等分化較好的神經分泌型肺癌也屬少見的肺癌。現今肺癌診斷常依賴細針穿刺切片檢查，正確診斷LCNEC需依靠精確的病理及免疫組織化學診斷。我們除了報告一例LCNEC病例，另外報告一例同屬神經分泌型，但較低惡性度的肺類癌(carcinoid)病例，並對其臨床特性與診斷依據提出淺見，以便對於神經內分泌肺腫瘤有全面的認識。
並列摘要
WHO have been recognized the large cell neuroendocrine carcinoma (LCNSC) as distinct clincopathological entities of lung cancer since 1999. Both LCNSC and small cell lung carcinoma (SCLC) are poorly differentiated neuroendocrine cancer of lung. The clinical symptoms, image and peripheral location of LCNEC are similar with nonsmall cell lung carcinoma (NSCLC). However, LCNEC has worse prognosis than NSCLC and it should be treated as SCLC on chemotherapy. It has proven that even early stage case of LCNEC should be treated with aggressive chemotherapy to prolong life, so pathological discrimination of LCNEC from other NSCLC is important. Modern diagnosis of lung cancer usually depends on fine needle biopsy, and is required sophisticated pathologic and immunohistochemical diagnostic works. Here we introduce a case of this new lung cancer category and emphasize the classification and diagnosis of LCNEC of lung cancer. In addition, we also introduce a case of carcinoid tumor, a lower grade neuroendocrine tumor of lung, in order to have thorough understanding of lung neuroendocrine tumors.
延伸閱讀
- Chen, C. W., Chiu, C. H., Chou, T. Y., Hsu, W. H., & Perng, R. P. (2006). 以不明原因腦轉移癌為起始表現的肺大細胞神經分泌性癌. 胸腔醫學, 21(5), 462-467. https://doi.org/10.29806/TM.200610.0010
- Leung, J. H., Shen, W. L., Ng, Y. B., Huang, C. L., Chen, W. P., & Lin, I. L. (2006). 肺部炎性肌纖維性腫瘤：病例報告. 中華放射線醫學雜誌, 31(1), 59-62. https://www.airitilibrary.com/Article/Detail?DocID=10188940-200602-31-1-59-62-a
- Chang, C. Y., Wu, C. T., Lin, C. H., Ho, C. C., & Yang, P. C. (2008). 成人第一型神經纖維瘤併發肺部惡性週邊神經鞘腫瘤轉移－一病例報告. 胸腔醫學, 23(1), 42-48. https://doi.org/10.29806/TM.200802.0008
- Lin, S. Y., Chen, J. S., Hsieh, M. S., & Ho, C. C. (2014). 瀰漫性自發肺部神經內分泌細胞增生－病例報告. 胸腔醫學, 29(6), 358-364. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201412-201411210019-201411210019-358-364
- Tsai, W. C., Yu, J. C., Sheu, L. F., & Nieh, S. (2006). Primary Neuroendocrine Carcinoma of the Breast. Journal of Medical Sciences, 26(2), 65-67. https://www.airitilibrary.com/Article/Detail?DocID=10114564-200604-201304030029-201304030029-65-67