细支气管腺瘤10例临床病理分析及文献复习  

Bronchiolar adenoma:a clinic pathological analysis of 10 cases and review of literature

作　　者：李娟 刘劲松[1,2] 李梅 李殿炜[1,2] 朱弘 LI Juan;LIU Jingsong;LI Mei;LI Dianwei;ZHU Hong(Department of Pathology,The Lu'an Hospital Affiliated to Anhui Medical University,,Anhui Luan 237005,China;Department of Pathology,The Lu'an People's Hospital,Anhui Luan 237005,China)

机构地区：[1]安徽医科大学附属六安医院病理科,安徽六安237005 [2]六安市人民医院病理科,安徽六安237005

出　　处：《诊断学理论与实践》2021年第5期466-470,共5页Journal of Diagnostics Concepts & Practice

摘　　要：目的:探讨细支气管腺瘤的临床病理特征、诊断及鉴别诊断。方法:收集六安市人民医院2020年1月至12月收治的10例细支气管腺瘤病例,总结其临床资料、影像学检查结果、组织病理学特征及免疫组织化学(免疫组化)表型。结果:患者中男性4例,女性6例,发病年龄为49~79岁。大多患者均无明显临床症状,仅在胸部CT检查时发现肺部磨玻璃样结节。10例患者病灶均位于肺外周,切面大部分为灰白结节,质地中等或质地软,肿瘤与周围正常肺组织界限尚清楚。6例患者为近端型,4例患者为远端型。在光学显微镜下观察,肿瘤呈腺腔型、平坦型及乳头型结构,可见大量细胞外黏液,腔缘内衬细胞为黏液细胞、纤毛细胞、非纤毛立方细胞、Clara细胞,细胞无异型性及未见核分裂象,腔缘外可见连续的基底细胞层,部分肿瘤可无黏液细胞和纤毛细胞。免疫组化标志物p40、p63、CK5/6均在基底细胞层连续显示。结论:细支气管腺瘤是一种由双层细胞构成的外周性肺肿瘤,诊断该疾病要求在病理检查中观察到完整的基底细胞层,明确诊断该病困难时,需进行免疫组化标志物(p40、p63和CK5/6)检测,明确基底细胞层的存在。Objective:To study the clinic pathological characteristics,diagnosis and differential diagnosis of bronchiolar adenoma.Methods:Ten cases of bronchiolar adenoma in Lu′an people′s Hospital were collected from January to December 2020,and their clinical data,imaging results,histopathological features and immunohistochemical phenotype were analyzed with literature reviewed.Results:Of the patients,there were 4 males and 6 females,with age ranging from49 to 79 years old.Most patients had no obvious clinical symptoms,and were found occasional pulmonary nodules by chest CT examination,with ground glass nodules on CT.All of the lesions were located in the periphery of the lung.Grossly,all of the tumors were well circumscribed,solid,and tan to brown on the cut surface.Six cases were the proximal type,and four case was the distal type.Microscopically,the tumor showed glandular,flat and papillary growth pattern,and a large amount of extracellular mucus could be seen.The lining cells of the cavity margin were mucous cells,ciliated cells,non-ciliated cuboidal cells and Clara cells.There was no atypia and mitosis.Continuous basal cell layer could be seen outside the cavity margin,and some tumors could be free of mucous cells and ciliated cells.Immunohistochemical staining of p40,p63 and CK5/6 showed the continuous basal cell layer.Conclusions:Bronchiolar adenoma is a kind of peripheral lung tumor composed of double-layer cells,the diagnosis requires the existence of a complete basal cell layer,and sometimes it is difficult to make a definite diagnosis.The existence of basal cell layer which is identified by immunological histochemistry(p40、p63 and CK5/6)is the key point for distinguish BA from lung adenocarcinoma.

关 键 词：肺肿瘤 细支气管腺瘤 免疫组织化学 

分 类 号：R541.7[医药卫生—心血管疾病]