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Vol.51 No.3 contents | Japanese/English |
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- Case Report -
A Case of Pulmonary Adenocarcinoma with Enteric Differentiation
Atsushi Fujita1, Yoshimasa Nakazato2, Keisei Tachibana2, Toshifumi Kazama3, Kouji Sato3, Kouichi Minato31Department of Thoracic Surgery, 2Department of Pathology, 3Department of Respiratory Medicine, Gunma Prefectural Cancer Center, Japan
Background. Pulmonary adenocarcinoma with enteric differentiation is a rare histologic type. It is important in such cases to distinguish between pulmonary adenocarcinoma and metastatic colorectal carcinoma. Case. A 74-year-old man underwent evaluation elsewhere for a productive cough. Computed tomography (CT) of the chest revealed a 57-mm mass in the right S3. Bronchoscopic evaluation revealed a polypoid lesion at the orifice of the right B3a. Histopathological examination revealed that the tumors formed ducts that composed of tall columnar cells. Immunohistochemical stains demonstrated positivity for CK20 in neoplastic cells with negative staining for CK7 and TTF-1. These findings were indicative of metastatic colorectal carcinoma. However, additional clinical investigation, including gastroscopy and colonoscopy, did not reveal any evidence of tumor elsewhere. He was given a diagnosis of primary lung cancer and underwent right upper lobectomy with systemic lymph node dissection. Final histopathological examination of the specimen suggested colorectal carcinoma, just as the bronchoscopic evaluation had. Immunohistochemical staining was positive for CK20 and CDX-2 and partly positive for MUC2 but negative for CK7, TTF-1 and SP-A, also indicating metastatic colorectal carcinoma. Nevertheless, the final diagnosis based on a clinical decision was primary pulmonary adenocarcinoma with enteric differentiation. Conclusion. Because it is difficult to diagnose pulmonary adenocarcinoma with enteric differentiation through histopathological or immunohistochemical examination, close inspection of the gastrointestinal tract is important.
key words: Lung cancer, Pulmonary adenocarcinoma with enteric differentiation, Immunohistochemistry
Received: December 15, 2010
Accepted: March 2, 2011
JJLC 51 (3): 188-192, 2011
