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　　双向分化癌是一种特殊类型的癌，以同种肿瘤细胞同时出现外分泌和内分泌为特征。这种肿瘤非常罕见，胃肠道是最常见的好发部位，肺少有报道。本文报道3例这类肿瘤，扩展了肺双向分化癌的谱系。3例病例均为男性，年龄为53～78岁(平均：63岁），均为吸烟者或有吸烟史。其中1例为偶然发现，另2例均有下呼吸道症状。镜下肿瘤呈器官样结构，细胞巢周边呈栅栏状，细胞体积大，胞核呈泡状，核仁明显，形似大细胞神经内分泌癌。此外，瘤细胞巢呈腺样结构，腺样腔隙内充满黏液，同时肿瘤细胞胞质内亦见黏液空泡。免疫组化显示突触素和嗜铬素弥漫阳性，TTF-1反应不一。黏液染色示细胞外和细胞内黏液沉积。临床随访发现，其中1例术后12个月死于该病；另1例术后21个月无病存活。第3例存活，但在确诊后8个月出现广泛转移。本文报道的病例为罕见的肺癌类型，表现为同时出现外分泌和内分泌分化。认识该类肿瘤对肿瘤分类和确定潜在的侵袭性行为非常重要。

Am J Surg Pathol 2018;42:1246-1252

美国外科病理学杂志中文版2019年第二期摘要NO.6

(孙 琦 翻译  刘 斌 审校）

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