摘要：

目的 报告1 例临床罕见的右侧额叶转移性沙砾体型肺乳头状腺癌患者，结合文献探讨其临床病理学特点、诊断与鉴别诊断要点。方法与结果 男性患者，56 岁，临床表现为额枕部间歇性头痛。MRI 显示右侧额叶占位性病变，考虑脑膜瘤可能。术中可见右侧额叶肿瘤呈灰红色、质地较韧、边界清楚、血供丰富。组织学形态观察，肿瘤组织呈乳头状结构，胞质嗜酸性，胞核呈圆形或卵圆形，可见小的红核仁，肿瘤组织和肿瘤间质中可见大量沙砾体形成；免疫组织化学染色，肿瘤细胞弥漫性表达细胞角蛋白（CK）、上皮膜抗原、CK19、甲状腺转录因子-1 和Napsin A 蛋白，灶性表达P53，Ki-67 抗原标记指数为5% ~ 10%；不表达胶质纤维酸性蛋白、S-100 蛋白、甲状腺球蛋白、Galectin-3 蛋白、孕激素受体、波形蛋白等标志物。结合胸部¹⁸F-FDG-PET CT 显像，最终病理诊断为（右侧额叶）转移性沙砾体型肺乳头状腺癌。术后辅以放射治疗和药物化疗，随访12 个月，肿瘤无复发。结论 中枢神经系统转移性沙砾体型肺乳头状腺癌临床罕见，应详细了解病史，并注意与乳头状型脑膜瘤、脉络丛乳头状瘤、乳头状型室管膜瘤、乳头状型胶质神经元肿瘤和转移性甲状腺乳头状癌等相鉴别，以免误诊或漏诊。

关键词: 腺癌, 乳头状, 肺肿瘤, 肿瘤转移, 额叶, 免疫组织化学, 病理学

Abstract:

Objective To investigate the clinical manifestations and pathological characteristics of pulmonary papillary adenocarcinoma with psammoma bodies metastasis to right frontal lobe of brain.  Methods  The clinical manifestations, pathological features and differential diagnosis were studied in one case of pulmonary papillary adenocarcinoma with psammoma bodies metastasis to right frontal lobe. Related literatures were also reviewed.  Results  A 56-year-old male suffered from intermittent headache for 3 years in fronto-occipital region without significant incentives. Cranial MRI examination revealed a space-occupying lesion in right frontal lobe, which was considered as meningioma. In operation, the tumor located in the right frontal lobe was tough and red-grey in color, with clear boundary and abundant blood supply. Histopathological examination revealed the tumor was arranged in papillary pattern. The tumor cells were large, with eosinophilic cytoplasm, round or oval nuclei and small red nucleoli. Especially, a plenty of psammoma bodies were found in tumor tissue and mesenchymal tissue. Immunohistochemical staining found that the tumor cells were positively expressed for cytokeratin (CK), epithelial membrane antigen (EMA), CK19, thyroid transcription factor-1 (TTF-1) and Napsin A, and showed focal positive expression of P53. Ki-67 labeling index was 5%-10%. The tumor cells were negative for glial fibrillary acidic protein (GFAP), S-100 protein (S-100), thyroglobulin (TG), Galectin-3 protein, progestrone receptor (PR) and vimentin (Vim). Combined with the results of chest ¹⁸F-FDG-PET CT, the final diagnosis was pulmonary papillary adenocarcinoma with psammoma bodies metastasis to right frontal lobe. The patient underwent auxiliary radiotherapy and chemotherapy after operation. The patient was followed for 12 months and no recurrence was seen.  Conclusions  This case is very rare. Understanding the patient's history and differentiating from other primary intracalvarium tumors is one of the key steps to give the right pathological diagnosis and clinical therapy. In order to avoid disdiagnosis, the diagnosis needs to be differentiated from other primary intracalvarium tumors, including papillary meningioma, papillary tumor of choroid plexus, papillary ependymoma, papillary glioneuronal tumors as well as metastatic papillary thyroid carcinoma.

Key words: Adenocarcinoma, papillary, Lung neoplasms, Neoplasm metastasis, Frontal lobe, Immunohistochemistry, Pathology