態娻
掕媊丗態峯宍惉丄擲塼嶻惗丄傑偨偼攛朎忋旂嵶朎儅乕僇乕(TTF-1, Napsin A)偑梲惈傪帵偡埆惈忋旂惈庮釃
慜怹弫惈昦曄 1999擭偍傛傃2004擭偺WHO暘椶偱偼丆態娻偺垷宆偲偟偰怹弫偺側偄態娻傪brochioloalveolar carcinoma (BAC)偲屇傃丆傑偨庮釃嵶朎偑婛懚偺攛朎暻偵増偭偰憹怋偡傞僷僞乕儞傪BAC僷僞乕儞屇傇傛偆偵丆BAC傪2庬椶偺堄枴偱梡偄偰偄傞丏傑偨丆昁偢偟傕梊屻偑椙岲偱偼側偄擲塼嶻惗惈偺BAC傕懚嵼偡傞丏1999擭偍傛傃2004擭偺WHO暘椶偱偼丆慜怹弫惈昦曄偲偟偰丆堎宍惉偲忋旂撪娻丆堎宆態庮條夁宍惉丆傃傑傫惈摿敪惈攛恄宱撪暘斿嵶朎夁宍惉傪偁偘偰偄傞偑丆BAC偼怹弫偺側偄態娻偱偁傞偺偵慜怹弫惈昦曄偵娷傑傟偰偄側偄丏偙偺傛偆側柕弬傪夝徚偡傞偨傔偵丆IASLC/ATS/ERS怴暘椶偱偼丆BAC偲偄偆梡岅偼梡偄偢丆偐傢傝偵lepidic僷僞乕儞傪梡偄丆態娻偺慜怹弫惈昦曄偲偟偰忋旂撪態娻傪壛偊偨丏
lepidic僷僞乕儞偲偼丠
堎宆態庮條夁宍惉丂Atypical adenomatous hyperplasia 乮AAH乯
堎宆態庮條夁宍惉偺戝偒偝偼丆捠忢5mm埲壓偱偁傝丆懡敪偡傞偙偲傕偁傞丏寉搙偐傜拞摍搙偺堎宆惈傪帵偡II宆攛朎忋旂嵶朎乮偁傞偄偼僋儔儔嵶朎乯偑攛朎暻乮偁傞偄偼屇媧嵶婥娗巟乯偵増偭偰憹惗偡傞偑丆嵶朎偲嵶朎偺娫偵寗娫偑傒傜傟傞丏妀撪晻擖懱偑傒傜傟傞丏堎宆惈偑嫮偔嵶朎枾搙偑崅偄応崌偼丆AAH偲忋旂撪態娻Adenocarcinoma in situ (AIS)偺娪暿偼擄偟偄丏
忋旂撪態娻丂Adenocarcinoma in situ (AIS)
廬棃偺BAC偱偁傞丏屒棫惈偱丆庮釃宎偑3cm埲壓偱丆婛懚偺攛朎暻偵増偭偰庮釃嵶朎偑憹怋偟乮lepidic僷僞乕儞乯丆娫幙丆寣娗丆嫻枌傊偺怹弫傪擣傔側偄傕偺傪偄偆丏擕摢宆丆旝彫擕摢宆傗攛朎峯撪偺庮釃嵶朎偼傒傜傟側偄丏戝敿偑擲塼旕嶻惗惈偱丆II宆攛朎忋旂偁傞偄偼Clara嵶朎偐傜側傞丏傑傟偵丆擲塼嶻惗惈忋旂撪態娻偑懚嵼偡傞丏偙傟偼丆崅墌拰忬嵶朎偐傜側傝丆妀偼婎掙晹偵暲傃丆嵶朎幙偵朙晉側擲塼傪擖傟偰偄傞丏
庮釃偑lepidic僷僞乕儞偺傒偐傜側偭偰傕丆庮釃宎偑3cm傪挻偊傞応崌偼丆lepidic predominant adenocarcinoma偲恌抐偟丆忋旂撪態娻偑媈傢傟傞偲僐儊儞僩傪偡傞丏
旝彮怹弫惈態娻丂Minimally invasive adenocarcinoma (MIA)
庮釃宎偑3cm埲壓偱丆lepidic僷僞乕儞偑桪埵偱丆怹弫宎偑0.5cm埲壓偺態娻傪旝彮怹弫惈態娻偲偡傞丏
怹弫偲偼丠
Lepidic僷僞乕儞偑桪埵偱傕丆庮釃宎偑3cm傪挻偊傞応崌傗丆怹弫宎偑0.5cm傪挻偊傞応崌偼丆lepidic predominant adenocarcinoma偲恌抐偡傞丏
怹弫惈態娻丂Invasive adenocarcinoma
IASLC/ATS/ERS怴暘椶偱偼丆崿崌宆態娻(adenocarcinoma mixed subtype)傪梡偄偢丆偙傟偵憡摉偡傞傕偺偲偟偰丆怹弫惈態娻傪梡偄傞丏庮釃撪偵懚嵼偡傞僷僞乕儞乮lepidic丆態朳宆丆擕摢宆丆旝彫擕摢宆丆擲塼嶻惗廩幚宆乯偺愯傔傞妱崌傪5%偒偞傒偱婰榐偡傞丏怹弫惈態娻偼丆桪埵側慻怐僷僞乕儞偵傛傝lepidic adenocarcinoma丆態朳宆(acinar adenocarcinom)丆擕摢宆(papillary adenocarcinoma)丆旝彫擕摢宆(micropapillary adenocarcinoma)丆廩幚宆(solid adenocarcinoma)偵垷暘椶偡傞丏廬棃崿崌宆態娻偵暘椶偝傟偰偄偨擲塼旕嶻惗惈BAC桪埵偺態娻偼丆lepidic predominant adenocarcinoma (LPA)偵暘椶偡傞丏
憗婜態娻偵偍偄偰旝彫擕摢宆偼梊屻偑晄椙偱偁傞丏
摿庩宆
摿庩宆偲偟偰丆怹弫惈擲塼態娻乮廬棃偺擲塼嶻惗惈BAC乯invasive mucinous adenocarcinoma丆僐儘僀僪態娻colloid adenocarcinoma丆戀帣宆態娻fetal adenocarcinoma乮掅堎宆搙丆崅堎宆搙乯丆挵宆態娻enteric adenocarcinoma傪偁偘偰偄傞丏
怹弫惈擲塼態娻丂Invasive mucinous adenocarcinoma
廬棃偺擲塼嶻惗惈(mucinous) BAC偼丆椪彴揑偵傕曻幩慄夋憸揑偵傕廬棃偺擲塼旕嶻惗惈(nonmucinous) BAC偲偼堎側傞丏偟偨偑偭偰丆偙偺庮釃偼埲慜偺nonmucinous BAC偲偼暿偵暘椶偟丆lepidic growth偲怹弫宎偵傛傝擲塼嶻惗惈忋旂撪態娻mucinous AIS, 擲塼嶻惗惈旝彮怹弫惈態娻mucinous MIA, 怹弫惈擲塼態娻invasive mucinous adenocarcinoma偵暘椶偡傞丏
擲塼嶻惗惈忋旂撪態娻丂Mucinous AIS
Mucinous AIS偼丆庮釃宎偑3cm埲壓偱丆怹弫偑側偄丏
擲塼嶻惗惈旝彮怹弫惈態娻丂Mucinous MIA
Mucinous MIA偼庮釃宎偑3cm埲壓偱丆怹弫宎偑0.5cm埲壓偱偁傞丏
怹弫惈擲塼態娻丂Invasive mucinous adenocarcinoma
怹弫惈擲塼態娻偼懡敪惈偱偁傝丆懠偺攛梩丆懳懁攛偵傕昦曄傪擣傔傞偙偲偑懡偄丏廃埻偺攛朎偵庮釃偑嶶晍忬偵峀偑傞偨傔庮釃偺嫬奅偼柧椖偱偼側偄丏庮釃嵶朎偼攖嵶朎條偁傞偄偼墌拰忬偱偁傞丏庮釃嵶朎偺堎宆惈偼捠忢丆寉搙偱偁傞丏怹弫惈擲塼態娻傕lepidic僷僞乕儞丆態朳宆丆擕摢宆丆旝彫擕摢宆丆廩幚宆偺奺僷僞乕儞傪帵偡丏擲塼傪嶻惗偟偰傕丆攖嵶朎條偁傞偄偼崅墌拰忬偱偼側偄応崌偼丆怹弫惈擲塼態娻偲偼偟側偄丏
擲塼嶻惗惈丒旕嶻惗惈崿崌宆態娻丂Mixed invasive mucinous and non-mucinous adenocarcinoma
擲塼嶻惗惈態娻偲擲塼旕嶻惗惈態娻偑崿崌偡傞偙偲偑偁傝丆偦傟偧傟偑10%埲忋傪愯傔傞丏
僐儘僀僪態娻丂Colloid adenocarcinoma
僐儘僀僪態娻偼丆嵶朎奜偵懡検偺擲塼傪擣傔丆攛朎峯偑奼挘偟丆攛朎暻偑攋夡偝傟偰偄傞丏庮釃嵶朎偼擲塼偺拞偵晜梀偟偰偄傞丏1999擭偍傛傃2004擭偺WHO暘椶偵婰嵹偑偁傞擲塼擷朎態娻mucinous cystadenocarcinoma偼嬌傔偰傑傟偱偁傝丆僐儘僀僪態娻偲摨偠僗儁僋僩儔儉偵偁傞偲峫偊傜傟傞偨傔丆僐儘僀僪態娻偵暘椶偡傞丏
戀帣宆態娻丂Fetal adenocarcinoma
戀帣宆態娻偼丆僌儕僐乕僎儞偵晉傓柍慄栄嵶朎偑態峯傪宍惉偟丆戀帣偺攛偵椶帡偟偰偄傞丏妀忋丆妀壓嬻朎傪擣傔傞丏掅堎宆搙戀帣宆態娻偼丆morule偲傛偽傟傞媴忬廤夠傪擣傔丆妀偵optically clear nucleus偲傛偽傟傞偡傝僈儔僗忬曄壔傪敽偆丏偙偺妀偼價僆僠儞偵晉傓[3]丏兝僇僥僯儞堚揱巕偺堎忢偵傛傝敪惗偟丆柶塽愼怓偱兝僇僥僯儞偼丆庮釃嵶朎偺妀偍傛傃嵶朎幙偑梲惈偵側傞[4, 5]丏崅堎宆搙戀帣宆態娻偼兝僇僥僯儞堚揱巕偺堎忢偼擣傔偢丆柶塽愼怓偱兝僇僥僯儞偼庮釃嵶朎偺嵶朎枌偑梲惈偵側傞丏慜幰偼屻幰傛傝傕庒擭幰偵敪惗偟丆梊屻偑椙岲偱偁傞丏
挵宆態娻丂Enteric adenocarcinoma
挵宆態娻偼挵忋旂傊偺暘壔傪敽偆嵶朎偑庮釃偺50%埲忋傪愯傔傞傕偺傪偄偆丏戝挵娻偺攛揮堏偲偼堎側傝丆慻怐憸偑懡嵤偱丆捠忢偺攛態娻偺慻怐憸傕傒傜傟傞丏庮釃嵶朎偼崅墌拰忬偱丆妀偺婾廳憌壔傪擣傔丆態峯宍惉丆擕摢忬憹怋傪帵偟丆饪忬攝楍傪帵偡偙偲傕偁傞丏柶塽愼怓偼挵忋旂傊偺暘壔傪帵偡CDX-2, CK20, MUC2側偳偑梲惈偵側傞丏栺敿悢偺徢椺偼丆CK7, TTF-1傕梲惈偵側傞偺偱丆攛尨敪偐戝挵娻偺揮堏偐偺娪暿偵栶棫偮丏
報娐嵶朎娻signet ring adenocarcinoma丆扺柧嵶朎態娻偼clear cell adenocarcinoma偼懠偺慻怐僷僞乕儞偵崌暪偟偰傒傜傟傞嵶朎妛揑曄壔偱偁傞丏偙傟傜偑懚嵼偡傞応崌偼丆偦偺慻怐僷僞乕儞偺斖埻傪婰榐偡傞傋偒偱偁傞偑丆廩幚宆偲偺娫偵椪彴揑側嵎堎偑傒傜傟側偄偨傔丆IASLC/ATS/ERS怴暘椶偺慻怐暘椶偐傜偼嶍彍偝傟偨丏偟偐偟丆ALK堚揱巕偺嵞峔惉偑懚嵼偡傞攛娻偵偼報娐嵶朎娻傪娷傓昿搙偑崅偔[6]丆ALK堚揱巕偺嵞峔惉傪敽偆態娻偼ALK tyrosine kinase inhibitor (TKI)偱偁傞crizotinib偑憈岟偡傞偙偲偑曬崘偝傟偰偄傞[7, 8]丏
報娐嵶朎娻偺憸傪帵偡態娻丂solid adenocarcinoma with signet ring cell feature
嵍恾丗報娐嵶朎娻偺憸傪帵偡娻嵶朎偑廩幚惈偵憹怋傪偟偰偄傞丏
塃恾丗FISH偵傛傝ALK堚揱巕偑揮嵗傪偍偙偟偰偄傞偙偲偑傢偐傞丏
Spread through air spaces (STAS)
庮釃偺曈墢偐傜廃埻偺攛朎峯撪偵旝彫擕摢忬偺僋儔僗僞乕丆廩幚惈朎憙丆屒棫惈庮釃嵶朎傪擣傔傞偙偲偑偁傞丏昦婜俬偺彫宆偺態娻偵懳偟偰晹暘愗彍傪偟偨応崌偵丆偙偺強尒偑偁傞偲嵞敪偺壜擻惈偑崅偄丏STAS偼庮釃偺恑揥條幃偱偁傝丆態娻偺僷僞乕儞偲偟偰偦偺愯傔傞妱崌傪應掕偟側偄丏傑偨丆庮釃宎偵傕擖傟側偄丏
態娻偺慻怐垷宆偲堚揱巕堎忢
態娻偺堚揱巕堎忢偲慻怐宆偵偼偁傞掱搙娭學偑偁傞丏KRAS撍慠曄堎偼怹弫惈擲塼態娻偱昿搙偑崅偔[2, 14]丆傑偨丆擕摢宆丆廩幚宆丆拞暘壔偐傜掅暘壔偺態娻偱昿搙偑崅偄[14-17]丏EGFR撍慠曄堎偼擲塼旕嶻惗惈lepidic僷僞乕儞丆旕廩幚宆偱昿搙偑崅偔[2, 16, 17]丆拞暘壔偐傜崅暘壔偺態娻偱昿搙偑崅偄[14]丏ALK堚揱巕偺嵞峔惉偼報娐嵶朎娻傪娷傓攛態娻偺昿搙偑崅偔[6]丆慻怐垷宆偼丆擕摢宆丆擲塼態娻偱昿搙偑崅偄[16]丏EGFR堚揱巕, ALK堚揱巕偺堎忢傪帵偡攛娻偺妀堎宆搙偼丆KRAS堚揱巕偺堎忢傪帵偡攛娻偺妀堎宆搙傛傝傕掅偄[16]丏
堷梡暥專
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