小细胞肺癌课件

Case0810257，1851508男，73岁，主因“咳嗽2月，伴胸闷气喘20天”入院。（左肺上叶开口处）癌细胞CK（+），CK-L（+），CK-H（-），CK7（-），NapsinA（-），TTF-1（+），Syn（++），CgA（+），CD56（++），Ki-67（70%+），结合HE切片，本例应为小细胞癌。2015.03.21复查SmallCellLungCarcinoma(SCLC)

SGY2015.04.28Introductionlungcancer：non–smallcelllungcarcinoma(non-SCLC)andSCLCSCLCsaccountfor13%–15%ofalllungcancersandarethemostcommonprimarypulmonaryneuroendocrineneoplasmCigarettesmokingisresponsibleforapproximately95%ofcases,andofallthehistologicsubtypesoflungcancer,SCLChasthestrongestassociationwithcigarettesmokingClassificationofPulmonaryNeuroendocrineNeoplasms(VALSG)Low-grade:typicalcarcinoidtumor(典型类癌）intermediate-grade:atypicalcarcinoids（非典型类癌）high-grade:largecellneuroendocrinetumorandSCLCEpidemiologicandClinicalFeaturesSCLCtypicallyaffectspatientsbetweentheagesof60and70yearsmen:women=2.6:1commonsigns:cough,chestpain,hemoptysis（咯血）,anddyspneaspecificsymptoms上腔静脉受压综合征食道及纵隔的侵犯副癌综合症：抗利尿激素异常分泌综合征（SIADH）,Cushing综合症,重症肌无力,脑脊髓炎,边缘叶脑炎神经内分泌症状比肿瘤的发现早2年HistologicandGrossPathologicFeaturesAtlightmicroscopy,SCLCischaracterizedbysmallblueround,oval,orspindle-shapedcellswithscantcytoplasm,ill-definedborders,finelygranularnuclearchromatin（核染色质颗粒）,andabsentorinconspicuousnucleoliOfthepulmonaryneuroendocrinetumors,SCLChasthehighestmitoticrateandextensivenecrosis.pureSCLCandcombinedSCLCImmunohistochemicalanalysisthediagnosisofSCLCtypicallyincludesapancytokeratinantibodysuchasAE1/AE3,CD56,chromogranin(嗜铬粒蛋白)-synaptophysin（突触素）,thyroidtranscriptionfactor1(TTF-1),orKi-67lymphoma(CD45andCD20)；primitiveneuroectodermaltumors（原始神经外胚层肿瘤）(CD99)；melanoma(S100)StagingofSCLCTheVALSGstagingsystemtraditionallydividedSCLCintoLS-SCLC（limited-stage）andES-SCLC（extensive-stage）----goodfortheassessmentofprognosisAJCC-TNM：StagesI–IIIcorrespondtoLS-SCLCandstageIVcorrespondstoES-SCLC----betterdifferentiatestage-specificsurvivalImagingofSCLCGeneralFeatures：Because90%–95%ofSCLCsarisefromlobarormainbronchi,themostcommonmanifestationofSCLCisalargemasscentrallylocatedwithinthelungparenchymaoramediastinalmassinvolvingatleastonehilumCT表现MostSCLCsarelocatedwithinthecentralaspectofthechestandmanifestasamediastinal(92%ofcases)orhilar(84%)lymphadenopathy.Contrast-enhancedCTcanbeusefulinrevealingtheextentofmediastinalinvasionIntratumoralcalcificationhasbeenreportedinupto23%ofpatientsPeripheraltumorstypicallymanifestaswell-defined,homogeneousnodulesormasseswithlobularmarginsandspiculations其他表现：癌性淋巴管炎:小叶间隔增厚及结节形成肺不张及梗阻性肺炎胸膜转移：胸水、胸膜增厚、胸膜结节心包转移：心包积液、心包增厚对侧肺叶及胸外转移PET/CTSCLCisreadilyidentifiedatFDGPETbecauseofitshighmetabolicactivity提高分期准确率治疗效果TreatmentofSCLCLS-SCLCistypicallytreatedwithacombinationofchemotherapyandearlyconcurrentthoracicirradiation,whereasES-SCLCistreatedwithsystemicchemotherapy.Chemotherapythemostcommonregimens:etoposide(依托泊苷)andcisplatin(顺铂),etoposideandcarboplatin(卡铂)Despitehighresponseratestofirst-linecombinationchemotherapy,approximately80%ofpatientswithLS-SCLCandvirtuallyallpatientswithES-SCLCdeveloprecurrentorprogressivediseaseForpatientswhoexperiencerelapsewithin3monthsofinitialtherapy(refractoryorresistantdisease),theresponseratetoadditionalchemotherapyislessthan15%ThoracicRadiationTherapyTRTistypicallyadministeredwithsystemicchemotherapyinpatientswithLS-SCLCtheadditionofTRTtoetoposide-cisplatinchemotherapyduringthefirstorsecondcycleisthecurrentstandardofcareforpatientswithLS-SCLCProphylacticCranialIrradiation（预防性脑照射）prophylacticcranialirradiationisnowrecommendedforpatientswitheitherLS-orES-SCLCwhodemonstrateagoodresponsetochemotherapyorchemotherapy–radiationtherapy.SurgerypatientswithstageIdiseaseatthetimeofdiagnosis(~5%)areusuallyconsideredforsurgicalresection.NaturalHistoryandPrognosismediansurvivaltimeafterdiagnosisisonly2–4monthsintheabsenceoftreatmentth