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- 肺癌，组织学分类？
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I don't think the solid areas show any real squamous differentiation. It is just poorly differentiated areas of adenocarcinoma. To my experience, it can also be negative for TTF-1. Recently I had a case of lung adenocarcinoma with positive TTF-1 in the primary tumour, negative for TTF-1 in the recurrent tumour (but the keratin pattern is the same). I went back to look the TTF-1 stain in the primary tumour and found a few TTF-1 negative cells in the poorly differentiated area. I think the recurrent tumour may rise from these TTF-1 negative cells.
这是一例异质性很大的非小细胞性肺癌。有腺和鳞的成分，还见到局部有黏液样间质和梭形细胞成分。就腺成分也存在很大的异质性，有经典腺癌成分，有细支气管肺泡癌成分（图9），还有的象唾腺来源嗜酸细胞腺癌的成分。
1. 如果有呈间质样梭形细胞的成分并达到或超过10%，可考虑报：多形性癌，并注明所含癌的类型，尽管没见巨细胞癌的成分；
2. 如果梭形成分或间叶样成分占10%以下，而腺/鳞比例基本相当或以一种为主(但不少于10%)，可以合并有大细胞癌成分（但除腺与磷外不能再有其他两种类型的成分），考虑报:腺磷癌。标记AE1/AE3、CK7、CAM5.2、TTF-1、34BE12等。
3. 如果有的区域（图8、10、11）有神经内分泌（NE）标记阳性，在腺/鳞的基础上根据NE成分的分布情况，可考虑伴有NE分化；有孤立的NE区，则可能为复合癌。
4.图1和2 乳头状增生如果没有异型性,又是在肿瘤邻近的支气管腔面，则可能是伴有鳞化并乳头状增生。
Dr.Jin8提供的病例总是一些具有挑战性的病例。有趣！谢谢！
- 王军臣
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AJCP just published a paper of oncocytic adenocarcinoma of the lung with TTF-1 positive as lung marker, some lumen contains esinophilic granules. If your case with tumor cell positive for TTF-1, I will favor non-small cell Ca with histological features consistent with adenoca.
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Although figures 1-2 suggest squamous cell carcinoma, some neoplastic cells in figure 2 (similar to that in figures 3 and 7-8) contain cytoplasmic mucin and all other photos show clear glandular differentiation. Therefore this is a moderately differentiated adenocarcinoma.
聞道有先後,術業有專攻
