肺纤毛黏液结节性乳头状肿瘤2例临床病理分析及文献复习

doi:10.16150/j.1671-2870.2018.05.018

摘要/Abstract

摘要： 目的：探讨肺纤毛黏液结节性乳头状肿瘤（ciliated muconodular papillary tumors,CMPT）的临床和病理组织学特征、免疫表型及鉴别诊断。方法：总结2例CMPT患者的临床病理资料,分析其临床表现、影像学特点、病理学特征及免疫表型,并结合相关文献进行探讨。结果：术中冷冻病理检查结果,1例患者诊断为微浸润性黏液腺癌,另1例考虑需鉴别CMPT与微浸润性黏液腺癌。术后石蜡组织显示其具有共同的特征性结构,肿瘤组织主要排列呈腺管状、乳头状结构,局部可呈贴壁状生长,也可形成微乳头状结构;肿瘤内及肿瘤周围肺泡腔内充满黏液,并形成黏液池;肿瘤间质常伴有淋巴细胞、浆细胞浸润;肿瘤由基底细胞、纤毛柱状细胞及黏液细胞3种细胞构成。3种肿瘤细胞均无异型性,无核分裂象,无肿瘤性坏死。免疫组织化学检查提示基底细胞表达P63及P40,部分表达TTF-1;纤毛柱状细胞及黏液细胞均表达CK7及MUC-1,部分或少数弱表达TTF-1、NapsinA、SP-A及P63,均不表达P40,少量纤毛细胞弱表达MUC5AC;3种细胞Ki-67均低表达。结论：肺CMPT是一种新近认识的少见肺肿瘤,其组织形态及免疫表型均具有特征性,3种肿瘤细胞的免疫组化表达不一致,但在影像学检查及术中冷冻病理检查中易被误诊为腺癌,确诊需要进行石蜡组织形态学观察和免疫组化标志检测。

关键词: 肺, 纤毛黏液结节性乳头状肿瘤, 临床病理, 免疫表型

Abstract: Objective: To investigate the clinical manifestation, pathological feature, immunophenotype, differential diagnosis of ciliated muconodular papillary tumor. Methods: Clinical data from two cases of CMPT were collected, analyzed retrospectively, including clinical, pathologic features, imaging findings, immunophenotype. Results: In frozen section examination during operation, one case was diagnosed as minimally invasive mucinous adenocarcinoma, the other was considered as CMPT or minimally invasive mucinous adenocarcinoma. Histologic findings of paraffin embedded tissue sections revealed that the tumor consisted of papillary, glandular architecture, a minimal extent of micropapillary structure, discontinuous lepidic growth. There was abundant extracellular mucin surrounding the tumor, which formed pools of mucin, with chronic inflammatory cell infiltration in the stroma. The epithelial components of the lesion consisted of ciliated columnar cells, mucous cells, basal cells. The basal cells provided a scaffold in the ou-ter layer, the ciliated columnar cells, mucous cells intermingled at the surface of the glandular/papillary structures. All three types of cells showed no nuclear atypia, no mitotic figures. Tissue necrosis was not observed. The basal cells expressed P63, P40, while a subset of basal cells expressed TTF-1. Both ciliated columnar cells, mucous cells expressed CK7, MUC-1, whereas TTF-1, Napsin A, SP-A, P63showed a patchy moderate intensity staining, P40showed no staining. The ciliated columnar cells were focally positive for MUC5AC. All three types of cells showed a low Ki-67index. Conclusions: CMPT of lung is a newly defined, extremely rare tumor with characteristic histological findings, immunophenotype. There is a potential diagnostic pitfalls for CMPT because it is easily misdiagnosed as mucinous adenocarcinoma by imaging findings, in the frozen section examination. The accurate pathologic diagnosis depends on the morphologic characteristics of paraffin-embedded tissue section, immunohistochemical staining

Key words: Pulmonary, ciliated muconodular papillary tumors, Clinicopathology, Immunophenotype

中图分类号:

R734.2

陈晓炎, 杨晓群, 袁菲, 张静, 王朝夫. 肺纤毛黏液结节性乳头状肿瘤2例临床病理分析及文献复习[J]. 诊断学理论与实践, 2018, 17(05): 575-580.

CHEN Xiaoyan, YANG Xiaoqun, YUAN Fei, ZHANG Jing, WANG Chaofu. Pulmonary ciliated muconodular papillary tumor: clinical pathologic analysis of two cases and review of literature[J]. Journal of Diagnostics Concepts & Practice, 2018, 17(05): 575-580.

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