硬化性肺细胞瘤20例术中冰冻病理诊断分析  

Intraoperative diagnosis of sclerosing pneumocytoma by frozen section:a clinicopathological analysis of twenty cases

作　　者：张桃桃 杨喆[2] 杨丹 宋思凡 张雨晖 刘希[2] ZHANG Tao-tao;YANG Zhe;YANG Dan;SONG Si-fan;ZHANG Yu-hui;LIU Xi(Department of Pathology,Shanxi Provincial Tuberculosis Prevention and Control Hospital,Xi’an 710105,China;Department of Pathology,the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine,Xi’an 710061,China)

机构地区：[1]陕西省结核病防治院病理科,西安710105 [2]西安交通大学医学院第一附属医院病理科,西安710061

出　　处：《诊断病理学杂志》2024年第12期1160-1164,共5页Chinese Journal of Diagnostic Pathology

基　　金：国家自然科学基金项目(81902414)。

摘　　要：目的 术中冰冻诊断硬化性肺细胞瘤(SP)一直具有挑战性。本研究探讨SP的临床病理学特点,以提高SP术中冰冻诊断准确性。方法 回顾性分析20例SP的临床病理资料,分析对比冰冻切片和石蜡切片的病理学特点。结果 术中冰冻:17例诊断为SP;1例诊断为梭形细胞肿瘤;1例诊断为低分化癌,倾向腺癌;1例肺泡上皮增生,考虑肿瘤边缘区改变。石蜡切片表现为2种细胞(立方状表面细胞与圆形间质细胞)和4种结构(乳头状、实性、硬化与血管瘤样结构)。免疫表型上,表面细胞和间质细胞均表达TTF-1和EMA,而AE1/AE3和CK7只表达于表面细胞。结论 避免冰冻误诊的关键需在肺结节的术中冰冻诊断中保持对SP的警惕性,结合影像学和大体检查评估肿瘤界限,组织学上识别SP特征性的生长结构模式和肿瘤中的两种细胞。Objective The diagnosis of sclerosing pneumocytoma(SP) by frozen section during operation has been challenging.This study was to investigate the clinicopathological features of SP to improve the accuracy of intraoperative freezing diagnosis.Methods The clinicopathological data of 20 cases of SP were retrospectively analyzed.The histopathological features of the frozen section and paraffin section were compared.Results Intraoperative frozen sectioning showed that 17 cases were diagnosed as SP;1 case as spindle cell tumor;1 case as poorly differentiated cancer tended to be adenocarcinoma and 1 case as alveolar epithelial hyperplasia,which might be the marginal zone of the tumor.The paraffin sections showed two types of cells(cuboidal surface cells and round stromal cells) and four types of structures(papillary,solid,sclerotic,and haemorrhagic).Immunophenotypically,both surface and stromal cells expressed TTF-1 and EMA,while AE1/AE3 and CK7 were only expressed in surface cells.Vimentin was only expressed in stromal cells.Conclusion The key to avoiding misdiagnosis is to maintain vigilance of SP during intraoperative frozen section of pulmonary nodular lesions,to evaluate tumor boundaries through imaging and gross examination,and to identify SP characteristic growth structure patterns and two types of tumor cells histologically..

关 键 词：硬化性肺细胞瘤 影像学表现 术中冰冻 病理诊断 

分 类 号：R734[医药卫生—肿瘤]