NSCLC中p40/TTF1共表达的临床病理相关性及文献复习
Clinicopathological correlation of p40/TTF1 co-expression in NSCLC and review of related literature
摘要：
TTF 1和Δ Np 63/p40因其敏感性和特异性而被用于区分低分化NSCLC中的ADC和SQC。TTF 1和Δ Np 63/p40在同一肿瘤细胞中同时表达的病例很少，并且对此类病例的临床病理特征、治疗和预后知之甚少。我们对1例TTF 1/p40共表达的NSCLC的电镜特征、免疫组化表达及分子变异进行了研究，并对相关文献进行了回顾和总结。我们的患者是一名58岁的男性，CT显示左肺占位。与文献中报告的所有其他病例一样，肿瘤呈实性生长，多角形细胞，嗜酸性细胞质和清晰可见的核分裂。免疫组化显示TTF-1、p40、CK 5/6、CK 7、P63和p53阳性，NapsinA和ALK阴性。电子显微镜显示肿瘤细胞的特点是腺细胞和鳞状细胞的双向分化，与以前的报告一致。第二代测序提示STK 11/LKB 1和NF 1基因共突变。STK 11/LKB 1和NF 1基因突变已在ADC和SQC中发现，且常与耐药和预后不良相关，但STK 11/NF 1共突变尚未报道，需要更多病例来揭示其相关性。p40/TTF 1在NSCLC中的共表达可能是NSCLC的一种未被充分认识的变异。起源可能是位于远端气道的双阳性干细胞样基底细胞，临床进展快，预后差。
英文摘要：
TTF1 and ΔNp63/p40 have been used to differentiate ADC and SQC in hypofractionated NSCLC because of their sensitivity and specificity. There are few cases where TTF1 and ΔNp63/p40 are expressed together in the same tumour cells, and little is known about the clinicopathological features, treatment and prognosis of such cases. We investigated the electron microscopic features, immunohistochemical expression and molecular variation of a case of TTF1/p40 co-expressing NSCLC and reviewed and summarised the relevant literature. Our patient was a 58-year-old male with a CT showing a left-sided lung occupancy. As in all other cases reported in the literature, the tumour showed a solid growth pattern with polygonal cells, eosinophilic cytoplasm and clearly visible nuclear fission. Immunohistochemistry showed positive for TTF-1, p40, CK5/6, CK7, P63 and p53, and negative for NapsinA and ALK. Electron microscopy showed tumour cells characterised by bidirectional differentiation of adenocytes and squamous cells, consistent with previous reports. Second-generation sequencing suggested co-mutation of STK11/LKB1 and NF1 genes in this case. Mutations in STK11/LKB1 and NF1 genes have been found in ADC and SQC and are often associated with drug resistance and poor prognosis, but STK11/NF1 co-mutation has not been reported and more cases are needed to reveal the association. p40/TTF1 co-expression in NSCLC may be an under-recognised variant of NSCLC The origin may be a double positive stem cell-like basal cell located in the distal airway, with rapid clinical progression and poor prognosis.
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