肺混合性鳞状细胞和腺性乳头状瘤的临床病理学观察

Analysis of clinicopathological features in pulmonary mixed squamous cell and glandular papilloma

关键词:  肺混合性鳞状细胞和腺性乳头状瘤  免疫组织化学  临床病理特征

Key words:  pulmonary mixed squamous cell and glandular papilloma  immunohistochemistry  clinicopathological features

摘要:

目的　探讨肺混合性鳞状细胞和腺性乳头状瘤的临床病理特征。方法　总结分析大连医科大学附属第一医院2例病理诊断为肺混合性鳞状细胞和腺性乳头状瘤的患者临床、影像及病理学资料。患者男女各1例；年龄分别为60岁及65岁；CT分别显示为右肺下叶混杂磨玻璃影及结节影，大小分别为1.1 cm×0.7cm及直径0.8 cm，形态均不规整且考虑为肿瘤性病变（其中1例HRCT考虑原位腺癌或微浸润腺癌）。2例均行右下肺叶楔形切除术。结果　显微镜下均见肿瘤与周边肺组织分界不清，由被覆鳞状上皮和/或腺上皮的乳头状结构组成，被覆的两种上皮可见组织学移行区，部分腺上皮形成嗜酸细胞微乳头，凸向腔内，有的脱落于腔内。周边肿瘤细胞延伸到肺泡腔并沿肺泡壁贴壁样生长，周边肺泡腔见大量粘液，与腺癌相似。免疫组化结果均显示不同种类的上皮具有相似的免疫表型。CK，CK7，CK5/6，P63，P40，Napsin-A和TTF-1在不同肿瘤细胞成分呈阳性，CK20，P16均呈阴性。2例患者术后随访时间分别为6个月及10个月，均未出现复发和转移。结论　肺混合性鳞状细胞和腺性乳头状瘤是罕见的肺良性肿瘤，临床及影像表现无特异性，正确诊断依赖于病理组织学及免疫组化。

Abstract:

Objective　 To study clinicopathological features of pulmonary mixed squamous cell and glandular papilloma. 　Methods　 Summary of the clinical, imaging and pathological findings of 2 patients with pathological diagnosis of pulmonary mixed squamous cell and glandular papilloma in our hospital. 　Results　 There was 1 female and 1 male patient. The ages were 65 and 60 years respectively. The CT showed mixed ground glass and nodules on the lower lobe of the right lung, with a size of 1.1 cm×0.7 cm and a diameter of 0.8 cm, respectively. Both of them considered as neoplastic lesions (HRCT considered the latter as adenocarcinoma or micro-invasive adenocarcinoma). Microscopically, the lesions were not demarcated by peripheral lung tissue. Papillary structures were covered with squamous epithelium and/or glandular epithelium, and in some area transitional epithelium between the two kinds of epithelium was also present. Eosinophilic micropapillae protruded from glandular epithelium, and some of them fell into the cavity. The tumor cells in peripheral lesion extended into the alveolar with lepidic-like pattern, and alveolar spaces were filled with mucus, which was similar to adenocarcinoma. Immunohistochemical analysis showed the different kinds of epithelia had similar immunophenotype. The different components were positive for pCK, CK7, CK5/6, P63, P40, Napsin-A and TTF-1, but negative for CK20 and P16. Two patients were followed up for 6 months and 10 months, respectively. No recurrence or metastasis occurred. 　Conclusions　 Pulmonary mixed squamous cell and glandular papilloma are rare benign tumors with no specific clinical and image manifestations,its correct diagnosis depends on histopathology and immunohistochemistry.