合并原发肺癌的细支气管腺瘤患者临床病理特征分析  

Clinicopathological features of patients with bronchiolar adenoma complicated with primary lung cancer

作　　者：吕玲[1] 李晓慧[1] 胡波[1] LÜLing;LI Xiaohui;HU Bo(Department of Pathology,Dalian University Affiliated Xinhua Hospital,Dalian 116000,Liaoning,China)

机构地区：[1]大连大学附属新华医院病理科,大连116000

出　　处：《中国临床医学》2024年第6期905-910,共6页Chinese Journal of Clinical Medicine

摘　　要：目的探讨伴有原发肺癌的细支气管腺瘤(bronchiolar adenoma,BA)的临床病理特征、诊断、鉴别诊断。方法收集大连大学附属新华医院2020年1月至2022年12月收治的17例伴有原发肺癌的BA患者的临床资料,总结其临床表现、组织病理学特征、免疫组织化学特点。结果17例患者中,男性7例、女性10例,年龄49~82岁;鳞癌2例、腺癌15例。BA大体呈结节状,无包膜,与周围肺组织界限清,最大径0.3~1.5 cm,切面呈灰白色、灰红色或灰褐色,质中至软,少数切面见明显黏液;镜下见BA由腔面细胞层和基底细胞层构成,腔面含数量不等的黏液细胞、纤毛细胞、立方细胞及柱状细胞。根据腔面细胞组成,将BA分为近端型和远端型。近端型5例;远端型12例,其中1例为非典型BA。免疫组织化学结果显示,16例典型BA基底细胞CK5/6、p63、p40阳性,腔面细胞及基底细胞甲状腺转录因子1(thyroid transcription factor 1,TTF-1)阳性,Ki-67增殖指数为1%。结论BA是良性肿瘤,主要由腔面细胞和基底细胞构成,当基底细胞缺失或不连续时,易被误诊为恶性,须高度警惕。Objective To analyze the clinicopathological features,diagnosis and differential diagnosis of bronchiolar adenoma(BA)with primary lung cancer.Methods Data of 17 BA patients complicated with primary lung cancer in Dalian University Affiliated Xinhua Hospital from January 2020 to December 2022 were collected,and the clinical data,histopathological features and immunohistochemical features were summarized.Results 17 patients included 7 males and 10 females,with 49-82 years old.There were 2 squamous cell carcinoma and 15 adenocarcinoma.BA was mostly nodular,without capsule.It had a clear boundary with the surrounding lung tissue,with a major diameter of 0.3-1.5 cm.The section of BA was gray-white,gray-red,gray�brown,with medium-soft texture,and a few had obvious mucus.Microscopically,it was composed of luminal cell layer and basal cell layer,and luminal cells contain mucus cells,ciliated cells,cubic cells and columnar cells.According to the composition of luminal cells,BAs were divided into proximal type and distal type.There were 5 proximal type and 12 distal type,including 1 case of atypical distal BA.Immunohistochemistry results showed that in typical BAs,CK5/6,p63 and p40 were positive in basal cells,thyroid transcription factor-1 was positive in luminal cells and basal cells,and the proliferation index of Ki-67 was 1%.Conclusions BA is a benign tumor,and is a bilayer structure mainly composed of luminal cells and basal cells.However,when the absence or discontinuity of basal cells,BA is easily misdiagnosed as malignancy,which should be highly vigilant.

关 键 词：细支气管腺瘤 肺癌 临床病理特征 误诊 

分 类 号：R734.1[医药卫生—肿瘤]