伴微乳头结构肺腺癌的临床病理特征及影像学特点  

Clinicopathological characteristics and imaging features of pulmonary adenocarcinoma with micropapillary pattern

作　　者：任剑飞[1] 周建娅[1] 丁伟[2] 钟百书[3] 周建英[1] 

机构地区：[1]浙江大学医学院附属第一医院呼吸内科,杭州310003 [2]浙江大学医学院附属第一医院病理科,杭州310003 [3]浙江大学医学院附属第一医院放射科,杭州310003

出　　处：《中华肿瘤杂志》2014年第4期282-286,共5页Chinese Journal of Oncology

基　　金：国家自然科学基金（81101768）

摘　　要：目的探讨伴微乳头结构（MPP）肺腺癌的临床病理特征和影像学特点。方法回顾性分析2011年7月至2012年12月手术切除的80例伴MPP肺腺癌患者的临床资料，分析其临床病理特征和影像学特点。结果80例伴MPP的肺腺癌患者中，Ⅰ期38例（47．5％），Ⅱ期12例（15．0％），Ⅲ期25例（31．3％），Ⅳ期5例（6．2％）。中分化14例（17．5％），中低分化66例（82．5％）。有胸膜侵犯、脉管侵犯、支气管壁累及、大血管累及、神经侵犯和淋巴结转移其中之一者63例（78．8％）。免疫组化结果显示，甲状腺转录因子1（TTF－1）和细胞角蛋白7（CK7）阳性率均为100％，表面活性剂载脂蛋白A（SPA）阳性率为84．0％。影像学检查结果显示，肺门或纵膈淋巴结肿大占18．8％，但病理确诊肺门或纵隔淋巴结转移者占45．0％。肺部影像以周围型为主，中央型较少，实性病灶多见，大部分伴分叶征、毛刺、胸膜凹陷征和血管集束征，磨玻璃影（GGO）和空泡征极少。结论伴MPP的肺腺癌早期就出现胸膜、血管、淋巴管和淋巴结浸润。影像学表现为周围型和实性病灶为主，多伴分叶征、毛刺征、胸膜凹陷征和血管集束征等，GGO和空泡征较少。TTF-1、CK7、SPA高表达和癌胚抗原升高与临床分期有关。Objective To explore the clinicopathological characteristics and imaging features of lung adenocarcinoma with a micropapillary pattern （MPP）. Methods Eighty cases of pulmonary adenocarcinoma with a micropapiUary pattern treated in our hospital from July 2011 to December 2012 were selected to retrospectively analyze their clinicopathological characteristics and imaging features. Results Among the 80 cases of lung adenocarcinoma with MPP, there were 38 cases of stage Ⅰ （47.5%）, 12 cases of stage Ⅱ （ 15.0% ）, 25 cases of stage Ⅲ （31.3% ） and 5 cases of stage Ⅳ （6.2%）. There were 14 cases of moderately differentiated （ 17.5% ） and moderately/poorly differentiated （ 82.5% ） tumors. Sixty-three cases had pleural involvement, vascular invasion, involving the bronchial wall, invasion of large vessels, nerve invasion, and lymph node metastasis （at least one of them） （78.8%）. Immunohistochemical staining revealed that both positive rates of TTF-1 and CK7 were 100%, and that of pulmonary surfactant apolipoprotcin-A （SPA） was 84.0%. Imaging examination revealed hilar or mediastinal lymph node enlargement in 15 cases （ 18.8% ）. but the pathology confirmed hilar or mediastinal lymph node metastasis in 36 cases （45.0%）. Lung CT imaging showed that the majority of the cases were peripheral type, and only a few of central type, and most cases were solid lesions, with lobulation, spiculation, pleural indentation, and vascular convergence sign, while there were few ground-glass opacity sign and vacuole sign. Conclusions Lung adenocarcinoma with MPP component often presents with early invasions of pleura, blood vessels, lymphatic vessels, and lymph nodes. Imaging manifestation of this cancer mainly shows as peripheral and solid lesions, often with lobulation, spiculation, pleural indentation, vascular convergence sign, but GGO and vacuole signs are unusual. Overexpression of TTF-1, CK7 and SPA, and elevated CEA level are associated with clinical staging of the disease.

关 键 词：肺肿瘤 腺癌 临床病理学 体层摄影术 X线计算机 微乳头结构 

分 类 号：R734.2[医药卫生—肿瘤]