细支气管腺瘤88例临床病理及分子特征  

Clinical and molecular characteristics of bronchial adenoma:an analysis of 88 cases

作　　者：徐青霞[1] 马廷廷 相龙全 侯英勇 卢韶华 袁伟 Xu Qingxia;Ma Tingting;Xiang Longquan;Hou Yingyong;Lu Shaohua;Yuan Wei(Department of Pathology,Jining No.1 People′s Hospital,Jining 272000,China;Department of Pathology,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China)

机构地区：[1]山东省济宁市第一人民医院病理科,济宁272000 [2]复旦大学附属中山医院病理科,上海200032

出　　处：《中华病理学杂志》2025年第4期368-374,共7页Chinese Journal of Pathology

基　　金：复旦大学附属中山医院临床专项基金(2020ZSLC01)。

摘　　要：目的探讨细支气管腺瘤(bronchial adenoma,BA)的临床病理特征、基因突变类型及分布。方法收集复旦大学附属中山医院病理科(71例)及山东省济宁市第一人民医院病理科(17例)2015年5月至2024年2月常规切片诊断为BA 88例,查阅其临床资料、影像学检查结果,复阅冷冻/常规组织病理学切片、免疫组织化学切片,复核基因检测结果。结果88例患者,男性36例,女性52例;近端型BA在两性中发病率相同(50%,28/56),远端型BA以女性多见(75%,24/32),差异有统计学意义(P=0.022)。BA好发于中老年人,发病年龄30~78岁,中位年龄为61岁。临床上一般无明显症状,影像学上主要表现为肺外周的磨玻璃样结节、混合性磨玻璃样结节或实性结节,主要分布于肺下叶(72.7%,64/88)。近端型BA以实性结节为主(53.6%,30/56),远端型BA以磨玻璃样结节为主(56.3%,18/32),差异有统计学意义(P<0.01)。肿瘤无包膜,切面灰白色,部分呈灰褐色,其中18.2%(16/88)的病例切面黏滑,质地软~中,边界欠清。切面出现黏滑感的病例主要出现于近端型BA中(14/16),肿瘤最大径0.2~4.6 cm。镜下病变呈腺管状、乳头状或者较平坦状形态,主要细胞成分为基底细胞、纤毛柱状细胞、黏液细胞及肺泡上皮细胞以不同比例组成。近端型BA形态类似于近端细支气管,常见黏液细胞和纤毛细胞,远端型BA通常缺乏黏液细胞及纤毛细胞。近端型BA纤毛细胞性微乳头出现频率(64.3%,36/56)高于远端型BA(31.3%,10/32),差异有统计学意义(P=0.003)。近端型BA腺腔扩张的形态表现(98.2%,55/56)比远端型BA(81.25%,26/32)更容易观察到,差异有统计学意义(P=0.009)。总体上冷冻切片诊断与常规切片诊断不一致率为(19.5%,17/87)。免疫组织化学细胞角蛋白5/6(CK5/6)及p40显示近端型BA基底细胞连续性(82.1%,46/56)高于远端型BA(56.2%,18/32),差异有统计学意义(P=0.009)。分子检测显示BA基因突变率为60.5%(23/38),基因突变ObjectiveTo investigate the clinicopathological features,gene mutations,and distribution of bronchial adenoma(BA).MethodsEighty-eight cases of BA diagnosed via routine section diagnosis between May 2015 and February 2024 were collected at the Pathology Departments of Zhongshan Hospital Affiliated to Fudan University(71 cases),Shanghai,China and Jining No.1 People′s Hospital(17 cases),Jining,China.Clinical data,image features,histopathological sections,immunohistochemical stains,and genetic testing results were reviewed.ResultsAmong the 88 patients with BA,there were 36 males and 52 females.The incidence of proximal-type BA was the same in both genders(50%,28/56),while distal-type BA was more commonly found in females(75%,24/32,P=0.022).BA predominantly affected middle-aged and elderly adults,with an age range of 30-78 years(median,61 years).Clinically,BA generally presented without obvious symptoms.Radiologically it mainly manifested as peripheral lung ground-glass nodules,mixed ground-glass nodules,or solid nodules,primarily located in the lower lobes of the lungs(72.7%,64/88).Proximal-type BA was characterized by solid nodules(53.6%,30/56),while distal-type BA by ground-glass nodules(56.3%,18/32),with a statistically significant difference between the two types(P<0.01).The tumor was non-encapsulated,with a gray-white cut surface,and some areas were gray-brown.In 18.2%(16/88)of cases,the cut surface was slippery,with soft to medium-firm consistency and poorly defined margins.The smooth texture was predominantly found in proximal-type BA(14/16),whose tumor diameters ranged from 0.2 to 4.6 cm.Microscopically,the lesions exhibited glandular,papillary,or relatively flat patterns,with the main cellular components consisting of basal cells,ciliated columnar cells,mucinous cells,and alveolar epithelial cells in various proportions.Proximal-type BA resembled the morphology of proximal bronchioles and commonly contained mucinous and ciliated cells,while distal-type BA typically lacked mucinous and ciliated cells.The fr

关 键 词：支气管肿瘤 DNA突变分析 免疫组织化学 

分 类 号：R734.1[医药卫生—肿瘤]