小細(xì)胞肺癌課件

Case0810257，1851508男，73歲，主因“咳嗽2月，伴胸悶氣喘20天”入院。（左肺上葉開口處）癌細(xì)胞CK（+），CK-L（+），CK-H（-），CK7（-），NapsinA（-），TTF-1（+），Syn（++），CgA（+），CD56（++），Ki-67（70%+），結(jié)合HE切片，本例應(yīng)為小細(xì)胞癌。2015.03.21復(fù)查SmallCellLungCarcinoma(SCLC)

SGY2015.04.28Introductionlungcancer：non–smallcelllungcarcinoma(non-SCLC)andSCLCSCLCsaccountfor13%–15%ofalllungcancersandarethemostcommonprimarypulmonaryneuroendocrineneoplasmCigarettesmokingisresponsibleforapproximately95%ofcases,andofallthehistologicsubtypesoflungcancer,SCLChasthestrongestassociationwithcigarettesmokingClassificationofPulmonaryNeuroendocrineNeoplasms(VALSG)Low-grade:typicalcarcinoidtumor(典型類癌）intermediate-grade:atypicalcarcinoids（非典型類癌）high-grade:largecellneuroendocrinetumorandSCLCEpidemiologicandClinicalFeaturesSCLCtypicallyaffectspatientsbetweentheagesof60and70yearsmen:women=2.6:1commonsigns:cough,chestpain,hemoptysis（咯血）,anddyspneaspecificsymptoms上腔靜脈受壓綜合征食道及縱隔的侵犯副癌綜合癥：抗利尿激素異常分泌綜合征（SIADH）,Cushing綜合癥,重癥肌無力,腦脊髓炎,邊緣葉腦炎神經(jīng)內(nèi)分泌癥狀比腫瘤的發(fā)現(xiàn)早2年HistologicandGrossPathologicFeaturesAtlightmicroscopy,SCLCischaracterizedbysmallblueround,oval,orspindle-shapedcellswithscantcytoplasm,ill-definedborders,finelygranularnuclearchromatin（核染色質(zhì)顆粒）,andabsentorinconspicuousnucleoliOfthepulmonaryneuroendocrinetumors,SCLChasthehighestmitoticrateandextensivenecrosis.pureSCLCandcombinedSCLCImmunohistochemicalanalysisthediagnosisofSCLCtypicallyincludesapancytokeratinantibodysuchasAE1/AE3,CD56,chromogranin(嗜鉻粒蛋白)-synaptophysin（突觸素）,thyroidtranscriptionfactor1(TTF-1),orKi-67lymphoma(CD45andCD20)；primitiveneuroectodermaltumors（原始神經(jīng)外胚層腫瘤）(CD99)；melanoma(S100)StagingofSCLCTheVALSGstagingsystemtraditionallydividedSCLCintoLS-SCLC（limited-stage）andES-SCLC（extensive-stage）----goodfortheassessmentofprognosisAJCC-TNM：StagesI–IIIcorrespondtoLS-SCLCandstageIVcorrespondstoES-SCLC----betterdifferentiatestage-specificsurvivalImagingofSCLCGeneralFeatures：Because90%–95%ofSCLCsarisefromlobarormainbronchi,themostcommonmanifestationofSCLCisalargemasscentrallylocatedwithinthelungparenchymaoramediastinalmassinvolvingatleastonehilumCT表現(xiàn)MostSCLCsarelocatedwithinthecentralaspectofthechestandmanifestasamediastinal(92%ofcases)orhilar(84%)lymphadenopathy.Contrast-enhancedCTcanbeusefulinrevealingtheextentofmediastinalinvasionIntratumoralcalcificationhasbeenreportedinupto23%ofpatientsPeripheraltumorstypicallymanifestaswell-defined,homogeneousnodulesormasseswithlobularmarginsandspiculations其他表現(xiàn)：癌性淋巴管炎:小葉間隔增厚及結(jié)節(jié)形成肺不張及梗阻性肺炎胸膜轉(zhuǎn)移：胸水、胸膜增厚、胸膜結(jié)節(jié)心包轉(zhuǎn)移：心包積液、心包增厚對側(cè)肺葉及胸外轉(zhuǎn)移PET/CTSCLCisreadilyidentifiedatFDGPETbecauseofitshighmetabolicactivity提高分期準(zhǔn)確率治療效果TreatmentofSCLCLS-SCLCistypicallytreatedwithacombinationofchemotherapyandearlyconcurrentthoracicirradiation,whereasES-SCLCistreatedwithsystemicchemotherapy.Chemotherapythemostcommonregimens:etoposide(依托泊苷)andcisplatin(順鉑),etoposideandcarboplatin(卡鉑)Despitehighresponseratestofirst-linecombinationchemotherapy,approximately80%ofpatientswithLS-SCLCandvirtuallyallpatientswithES-SCLCdeveloprecurrentorprogressivediseaseForpatientswhoexperiencerelapsewithin3monthsofinitialtherapy(refractoryorresistantdisease),theresponseratetoadditionalchemotherapyislessthan15%ThoracicRadiationTherapyTRTistypicallyadministeredwithsystemicchemotherapyinpatientswithLS-SCLCtheadditionofTRTtoetoposide-cisplatinchemotherapyduringthefirstorsecondcycleisthecurrentstandardofcareforpatientswithLS-SCLCProphylacticCranialIrradiation（預(yù)防性腦照射）prophylacticcranialirradiationisnowrecommendedforpatientswitheitherLS-orES-SCLCwhodemonstrateagoodresponsetochemotherapyorchemotherapy–radiationtherapy.SurgerypatientswithstageIdiseaseatthetimeofdiagnosis(~5%)areusuallyconsideredforsurgicalresection.NaturalHistoryandPrognosismediansurvivaltimeafterdiagnosisisonly2–4monthsintheabsenceoftreatmentth