CAJ | 학술논문

目的：观察间变性淋巴瘤激酶（ ALK）融合基因阳性肺鳞状细胞癌（ SCCL）临床病理特征、临床治疗效果，探讨对肺鳞癌患者进行ALK融合基因检测的必要性。方法 Ventana全自动免疫组化染色检测l例ALK蛋白阳性肺鳞状细胞癌患者，结合临床及影像学资料，观察组织学形态和常规免疫组化染色，分析患者临床治疗及预后。结果患者女性，54岁，不吸烟，因左背部疼痛伴咳嗽、咳痰2月余就诊。胸部CT示左肺门软组织密度影，左肺上叶支气管开口狭窄。支气管镜见左肺上叶支气管开口处新生物阻塞气道。头部MRI及骨扫描均提示有远处转移。支气管活检组织病理及免疫组化诊断：鳞状细胞癌，Ventana全自动免疫组化染色ALK蛋白阳性，表皮生长因子受体呈野生型。患者经吉西他滨联合顺铂化疗2周期，疾病进展；口服克唑替尼治疗病变缩小，疗效评价疾病稳定，疾病无进展生存期达6个月。结论肺鳞状细胞癌发生ALK重排罕见，针对ALK阳性肺鳞癌患者应用克唑替尼治疗有效；肺鳞癌患者有必要进行ALK筛查，使ALK融合基因阳性肺癌患者获益于靶向治疗。
목적：관찰간변성림파류격매（ ALK）융합기인양성폐린상세포암（ SCCL）림상병리특정、림상치료효과，탐토대폐린암환자진행ALK융합기인검측적필요성。방법 Ventana전자동면역조화염색검측l례ALK단백양성폐린상세포암환자，결합림상급영상학자료，관찰조직학형태화상규면역조화염색，분석환자림상치료급예후。결과환자녀성，54세，불흡연，인좌배부동통반해수、해담2월여취진。흉부CT시좌폐문연조직밀도영，좌폐상협지기관개구협착。지기관경견좌폐상협지기관개구처신생물조새기도。두부MRI급골소묘균제시유원처전이。지기관활검조직병리급면역조화진단：린상세포암，Ventana전자동면역조화염색ALK단백양성，표피생장인자수체정야생형。환자경길서타빈연합순박화료2주기，질병진전；구복극서체니치료병변축소，료효평개질병은정，질병무진전생존기체6개월。결론폐린상세포암발생ALK중배한견，침대ALK양성폐린암환자응용극서체니치료유효；폐린암환자유필요진행ALK사사，사ALK융합기인양성폐암환자획익우파향치료。
Objective To observe the clinicopathological characteristics of the patient with ALK rearrangement in squamous cell carcinoma of the lung(SCCL)and analyze the responsivity of clinical therapy and prognosis of the patient. To explore the necessity of ALK testing in SCCL. Methods A 54-year-old woman was involved in this observation. The clinical records,computerized tomographic checkup,pathological morphol-ogy and immunohistochemistry of the case were discussed. ALK rearrangement was screened by using immunohistochemistry on Benchmark XT au-tostainer. Results A 54-year-old,female,never-smoking patient presented with left back pain and cough,expectoration for two months. Com-puted tomography revealed a mass in left hilar area with bronchial stenosis in superior lobe of the left lung. Bronchoscopic exploration showed that a mass prominent to the cavity of left upper lobe bronchus and blocked airway. MRI scanning of the brain and bone scanning verified the presence of metastasis. She was diagnosed as squamous cell carcinoma without EGFR mutation. Ventana immunohistochemistry showed positive ALK expression. This case was administrated gemcitabine combined with cisplatin as first-line chemotherapy for 2 cycles,but tumor still got progression;however, when she received crizotinib therapy,the primary tumor shrank. Progression-free survival was 6 months. Conclusion ALK rearrangement in SCCL is uncommon,crizotinib showed effective in ALK-positive SCCL. So it is necessary for SCCL to screen ALK rearrangement.