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@#Objective To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group (n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group (n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results There was no significant difference in the baseline data between the two groups (P>0.05). No perioperative death was found. There was no statistical difference in the operation time (111.2±30.0 min vs. 107.3±34.3 min), blood loss (54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration (2.8±0.6 d vs. 2.6±0.6 d), hospital stay time (3.9±2.3 d vs. 3.7±1.1 d) or pathology staging (P>0.05) between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group (0.2±0.3 L vs. 0.4±0.3 L, P=0.005; 0.3%±8.1% vs. 2.9%±7.4%, P=0.041). Conclusion Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.
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Objective:To explore the efficacy and safety of neoadjuvant chemoimmunotherapy combined with surgery for stage ⅢA NSCLC patients.Methods:Six patients with NSCLC who were diagnosed as ⅢA and received two cycles of neoadjuvant chemoimmunotherapy and surgery between September 2019 and January 2020 were described in this study.Results:Five of them experienced AEs during neoadjuvant therapy. All of them received surgery and achieved an MPR of 50%. No viable tumor cells were found in the tissues of one patient. One patient with a small bronchopleural fistula after lobectomy.Conclusion:Neoadjuvant chemoimmunotherapy combined with surgery for stage ⅢA NSCLC patients is safe and efficient. Long-term outcomes of neoadjuvant chemoimmunotherapy combined with surgery should be further validated.
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Objective@#To investigate the clinical features of ciliated muconodular papillary tumor(CMPT) of the lung.@*Methods@#We retrospectively reviewed 11 cases with final pathology being diagnosed as CMPT in our department from April 2017 to April 2018. There were 8 males and 3 females with a mean age of(63.7±5.6) years. The clinical data, histopathological features, treatment, and prognosis were reviewed. All patients received CT scan before operation.@*Results@#The radiological features of CMPT include: located peripherally and most in right lower lobe; most CMPT lesions are GGO, some with air spaces in center and few being solid. All patients underwent video-assisted thoracic surgery(VATS) successfully, and there were no severe perioperative complications. The mean operating time was(78.0±28.2) min. The mean blood loss was(37.3±14.9) ml. The mean postoperative hospital stays were(3.45±0.93) days. Pathology examination of all patients were CMPT. Follow-up time ranged from 6 to 18 months and no recurrence was found.@*Conclusion@#CMPT is rare tumor, without specific clinical manifestation, but sometimes misdiagnosed as adenocarcinoma in situ or minimally invasive adenocarcinoma. VATS is feasible and safe for CMPT, and the prognosis is good.
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Objective To investigate the clinical features of ciliated muconodular papillary tumor( CMPT) of the lung. Methods We retrospectively reviewed 11 cases with final pathology being diagnosed as CMPT in our department from April 2017 to April 2018. There were 8 males and 3 females with a mean age of(63. 7 ± 5. 6) years. The clinical data, histopatho-logical features, treatment, and prognosis were reviewed. All patients received CT scan before operation. Results The radio-logical features of CMPT include:located peripherally and most in right lower lobe;most CMPT lesions are GGO, some with air spaces in center and few being solid. All patients underwent video-assisted thoracic surgery( VATS) successfully, and there were no severe perioperative complications. The mean operating time was(78. 0 ± 28. 2) min. The mean blood loss was (37. 3 ± 14. 9) ml. The mean postoperative hospital stays were(3. 45 ± 0. 93) days. Pathology examination of all patients were CMPT. Follow-up time ranged from 6 to 18 months and no recurrence was found. Conclusion CMPT is rare tumor, without specific clinical manifestation, but sometimes misdiagnosed as adenocarcinoma in situ or minimally invasive adenocarcinoma. VATS is feasible and safe for CMPT, and the prognosis is good.
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Objective@#To compare droplet digital PCR (ddPCR) and Super-amplification refractory mutation system (ARMS) in the detection of T790M mutation of epidermal growth factor receptor (EGFR) in the plasma of non-small cell lung cancer patients who had developed resistance to EGFR tyrosine kinase inhibitor (TKI) , and to investigate the clinical application of ddPCR.@*Methods@#Plasma samples were collected from non-small cell lung cancer patients who had acquired EGFR-TKI resistance at Shanghai Pulmonary Hospital, Tongji University, from May 2017 to November 2017. Extracted ctDNA was analyzed by ddPCR and Super-ARMS to evaluate the T790M mutation status of EGFR gene.@*Results@#A total of 37 patients with activating EGFR mutation that acquired resistance to EGFR-TKI were selected in the study, including 17 male and 20 female with a median age of 64 years (range 40-83 years). Before TKI treatment, all the patients harbored EGFR inhibitor sensitive mutations but without T790M mutation. After acquiring resistance to EGFR-TKI treatment, the T790M mutation rate detectable by ddPCR was 45.9% (17/37). In contrast, the mutation rate of T790M detectable by Super-ARMS was 35.1% (13/37, P<0.05). For the 13 positive cases detected by Super-ARMS (ΔCt<8), they were all positive by ddPCR assay; Among the 10 negative cases detected by Super-ARMS (ΔCt≥8), there were 3 cases positive by ddPCR assay. For patients without ΔCt by Super-ARMS assay, there was one weak positive case detectable by ddPCR assay. Among 17 EGFR T790M positive patients, 9 received EGFR inhibitor Osimertinib treatment, and 7 of them had good therapeutic response after the treatment.@*Conclusions@#While a significant correlation between the two methods is shown. ddPCR is more sensitive than Super-ARMS in the detection of EGFR T790M mutation, indicating that it is a better method in guiding target drug therapy of non-small cell lung cancer patients after acquiring the resistance to EGFR-TKI.
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Objective@#To investigate the clinicopathologic features and genetic profile of large cell lung carcinoma (LCC) redefined by new classification.@*Methods@#Basing on 2015 WHO classification criteria in redefining large cell lung carcinoma, the expression of specific markers (TTF1, Napsin A, p40, CK5/6, CK, vimentin and ZEB1) was detected by immunohistochemistry and D-PAS staining in 303 surgically-removed lung specimens previously diagnosed as large cell lung carcinoma. The clinicopathologic and genetic characteristics (including EGFR, KRAS, BRAF, ALK and ROS1 gene mutation) were analyzed.@*Results@#Based on the new definition of LCC, 116 cases (116/303, 38.3%) of LCC formerly diagnosed were reclassified as solid adenocarcinoma, 49 cases (49/303, 16.2%) as squamous cell carcinoma, 6 cases (6/303, 2.0%) as adenosquamous carcinoma, 22 cases (22/303, 7.3%) as spindle cell carcinoma and only 110 cases (110/303, 36.3%) as large cell carcinoma. Redefined LCCs were characterized as middle-age (range 40-80), male (102/110, 92.7%) and smoking patients (64/110, 58.2%) with intermediate-advanced stage. Among 110 cases, 9 cases with EGFR mutation and 10 cases with KRAS mutation and 1 case with ALK fusion were found. No BRAF and ROS1 alterations were identified.@*Conclusions@#According to the new classification, LCCs formerly diagnosed are mostly reclassified as adenocarcinoma and non-keratinizing squamous cell carcinoma. The newly defined LCC may significantly benefit from clinical therapy.
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<p><b>OBJECTIVE</b>To study the expression of squamous cell markers p63, p40 and CK5/6 in small cell carcinoma of lung (SCLC).</p><p><b>METHODS</b>Immunohistochemical study for squamous cell markers (p63, p40 and CK5/6), neuroendocrine markers (chromogranin A, synaptophysin and CD56) and TTF1 was carried out in 283 cases of SCLC. The diagnostic value of these markers was evaluated.</p><p><b>RESULTS</b>The expression rate of p63, p40 and CK5/6 were 20.7% (54/261), 7.9% (5/63) and 0.5% (1/221), respectively in the cases of SCLC studied. Amongst the squamous cell markers, CK5/6 had the lowest rate of positivity (P < 0.01). On the other hand, chromogranin A, synaptophysin and CD56 were positive in 61.8% (170/275), 85.5% (242/283) and 89.2% (248/278), respectively. The positivity rate for chromogranin A was lower than that for synaptophysin and CD56 (P < 0.01). TTF1 was expressed in 77.2% (217/281).</p><p><b>CONCLUSIONS</b>p63 and p40 are expressed in a subset of SCLC. In contrast, CK5/6 is rarely positive in SCLC. An immunohistochemical panel of CK5/6, synaptophysin and CD56 is recommended for differential diagnosis of SCLC.</p>
Subject(s)
Humans , CD56 Antigen , Genetics , Metabolism , Chromogranin A , Genetics , Metabolism , DNA-Binding Proteins , Genetics , Metabolism , Diagnosis, Differential , Keratin-5 , Genetics , Metabolism , Keratin-6 , Genetics , Metabolism , Lung Neoplasms , Genetics , Metabolism , Small Cell Lung Carcinoma , Genetics , Metabolism , Synaptophysin , Genetics , Metabolism , Transcription Factors , Genetics , Metabolism , Tumor Suppressor Proteins , Genetics , MetabolismABSTRACT
Purpose To analyze retrospectively the clinicopahological characteristics and immuophenotype in 120 cases of pulmonary selerosing hemangioma ( PSH) . Methods Data of 120 cases of PSH were collected and reviewed, including gross features and frozen diagnosis, histopathological features, morphology in HE and immunohistochemical characteristics of tumor cells. Results PSH pres-ents a well-circumscribed mass with a sense of expansion after cutting, which showed a solid, grey to tan-yellow surface with foci of haemorrhage. Two kinds of tumor cells and four typical patterns with mixed forms, are often shown under light microscope (92/120, 76. 67%). Focal accumulation of histocytes and scattered mast cells were noted in some cases (83/120, 69. 17%). Both surface cells and round cells were TTF-1 and EMA positive. Surface cells expressed SP-A, CK and NapsinA. Round cells expressed vimentin. Conclusion Gross features and typical“two cell types, four patterns” contribute to PSH diagnosis. Meanwhile, foal accumulation of foam histocytes and scattered mast cells show a clue to PSH diagnosis and differential diagnosis.