Abstract：
An 82-year-old woman with COPD presented to the emergency department with cough, increasing sputum production, wheezing, and worsening shortness of breath for two weeks. On imaging studies, the patient was found to have a right upper lobe spiculated nodule and an endobronchial lesion with near total occlusion of the right lower lobe bronchus with sub-segmental atelectasis. Bronchoscopy with EBUS-TBNA of subcarinal and right hilar lymph nodes revealed lung cancer with clear cell phenotype. Given the predominance of clear cell morphology, the diagnosis of metastatic renal or ovarian cancer was entertained. However, there was no evidence of renal or ovarian lesions on the PET-CT scan, ruling out the possibility. Salivary gland type lung cancer (STLC), which is responsible for less than 1% of all lung cancer cases in adults, was also considered. The two distinct STLCs that may have similar morphologic appearances are hyalinizing clear cell carcinoma (HCCC) and mucoepidermoid carcinoma (MEC). The other type of tumour in the lung that demonstrates a clear cell phenotype is perivascular epithelioid cell neoplasms or PEComa, which are mesenchymal in origin. Immunohistochemical staining was strongly positive for p63, CK5/6, CK7, CK-LMW, and negative for TTF-1, Napsin A, p16, and CK20. Additional staining, including HMB-45, S-100, and mucicarmine, were also negative. Next-generation sequencing for the salivary gland fusion panel, including EWSR1-ATF1 fusion and EWSR1 gene rearrangement for HCCC and MAML2 gene rearrangements for MEC, was negative. She was diagnosed with non-small cell lung cancer favouring squamous cell carcinoma with clear cell phenotype, a rare entity.
摘要：
一名82岁患有慢性阻塞性肺病的女性因咳嗽出现在急诊科，增加痰液产量，喘息,呼吸急促持续两周.在影像学研究中，该患者被发现有右上叶针状结节和支气管内病变，右下叶支气管几乎完全闭塞，伴有亚节段肺不张。隆突下及右侧肺门淋巴结行EBUS-TBNA支气管镜检查显示肺癌细胞表型透明。鉴于透明细胞形态的优势，诊断为转移性肾癌或卵巢癌。然而,PET-CT扫描没有肾脏或卵巢病变的证据,排除了可能性。涎腺型肺癌（STLC），占所有成人肺癌病例的不到1%，也考虑过。可能具有相似形态表现的两种不同的STLC是透明透明细胞癌（HCCC）和粘液表皮样癌（MEC）。肺中显示透明细胞表型的另一种类型的肿瘤是血管周围上皮样细胞肿瘤或PEComa，它们的起源是间充质的。免疫组织化学染色对p63、CK5/6、CK7、CK-LMW、对TTF-1，NapsinA呈阴性，p16和CK20。额外的染色，包括HMB-45、S-100和粘液碱，也是负面的。唾液腺融合组的下一代测序，包括EWSR1-ATF1融合和HCCC的EWSR1基因重排和MEC的MAML2基因重排，是阴性的。她被诊断为非小细胞肺癌，有利于鳞状细胞癌的透明细胞表型，一个罕见的实体。
