论著

肺混合性鳞状细胞和腺性乳头状瘤2例临床病理特征及冷冻切片病理诊断误诊分析

展开
  • 1.上海交通大学医学院附属瑞金医院病理科,上海 200025
    2.上海交通大学医学院附属瑞金医院海南医院(博鳌研究型医院)病理科,海南 琼海 571473

收稿日期: 2021-11-17

  网络出版日期: 2022-11-07

Pulmonary mixed squamous cell and glandular papilloma clinicopathological characteristics of 2 cases and misdiagnosis analysis of frozen section

Expand
  • 1. Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2. Department of Pathology, Ruijin-Hainan Hospital, Shanghai Jiao Tong University School of Medicine(Boao Research Hospital), Hainan, Qionghai 571473, China

Received date: 2021-11-17

  Online published: 2022-11-07

摘要

目的:探讨肺混合性鳞状细胞和腺性乳头状瘤(pulmonary mixed squamous cell and glandular papilloma,PMSGP)的临床病理特征,并分析该病的冷冻切片病理诊断要点及误诊原因。方法:收集2019年至2021年上海交通大学医学院附属瑞金医院经术后石蜡切片病理检查确诊为PMSGP的病例2例,并结合文献分析其临床病理特点及冷冻切片病理检查误诊的原因。结果:2例患者分别为74岁的女性及66岁的男性,均为体检发现肺占位,其中1例伴有胸闷胸痛,影像学检查均考虑为恶性肿瘤,行肺叶切除术。术中冷冻切片病理检查结果,1例考虑为黏液腺癌,1例考虑为PMSGP,但不能排除黏液表皮样癌。术后石蜡切片病理检查显示,2例患者的肿瘤体积分别为3.0 cm×2.5 cm×2.5 cm和1.7 cm×1.7 cm×1.6 cm,肿瘤细胞排列呈乳头状,表面被覆腺上皮及鳞状上皮,乳头轴心有较多炎症细胞,鳞状上皮有轻-中度不典型性,核分裂象罕见,无坏死。免疫组织化学检查示,2例患者的肿瘤组织中,腺上皮细胞表达CK7和TTF-1,黏液柱状上皮表达MUC5AC,鳞状上皮及基底细胞表达CK5/6、P63和P40,Ki-67仅在基底层高表达。2例荧光原位杂交(fluorescence in situ hybridization,FISH)检测均未发现MAML2基因重排。2例患者分别随访9个月及24个月,均无复发或转移。复习相关文献报道的39例PMSGP患者,冷冻切片病理检查的肿瘤性质误诊率高达52.6%,误诊原因主要为PMSGP与黏液表皮样癌及黏液腺癌等恶性肿瘤存在形态学交叉,且被覆鳞状上皮的不典型性在冷冻切片病理诊断时容易被放大。结论:PMSGP为肺部少见的良性肿瘤,术中冷冻切片病理检查误诊率高。冷冻切片中,PMSGP肿瘤的形态特征包括境界清楚,呈乳头状结构,乳头被覆鳞状上皮及腺上皮,基底细胞沿纤维血管轴心栅栏状排列,细胞排列有层次感,无异型性。

本文引用格式

车稳, 柳蒋书, 陈晓炎, 王朝夫, 袁菲, 王璇 . 肺混合性鳞状细胞和腺性乳头状瘤2例临床病理特征及冷冻切片病理诊断误诊分析[J]. 诊断学理论与实践, 2022 , 21(04) : 476 -481 . DOI: 10.16150/j.1671-2870.2022.04.010

Abstract

Objective: To discuss the clinicopathologic characteristics of pulmonary mixed squamous cell and glandular papilloma(PMSGP), and to analyze the key points for diagnosis and the causes of misdiagnosis of frozen section. Methods: Two cases of PMSGP diagnosed by pathology at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from 2019 to 2021 were enrolled, and the clinicopathologic and immunohistochemical characteristics and key points of frozen section diagnosis were analyzed based on literature review. Results: Two patients, a 74-year-old female and a 66-year-old male, were found to have pulmonary nodules in physical examination. One patient had chest tightness and pain. All nodules were considered as malignant tumors on imaging and lobectomy was performed. Frozen sections indicated one case was diagnosed as mucinous adenocarcinoma and the other diagnosed as PMSGP, but mucoepidermoid carcinoma could not be ruled out. In the paraffin section, the tumor sizes of 2 cases were 3.0 cm×2.5 cm×2.5 cm and 1.7 cm×1.7 cm×1.6 cm respectively. PMSGP displayed a papillary growth pattern lined by glandular epithelial cells and squamous cells. Inflammatory cells were observed along the papillary axis. Squamous epithelium could be mild to moderately atypical with rare mitosis and no necrosis. Immunohistochemistry examination showed that CK7 and TTF-1 were expressed in glandular epithelial cells, MUC5AC was expressed in mucinous columnar epithelial cells, squamous cells and basal-like cells expressed CK5/6, P63, P40 and Ki-67 was highly expressed only in the basal layer. MAML2 rearrangement was not detected in the 2 cases by FISH. No recurrence or metastasis was observed at 9 and 24 months of follow-up. A literature review of 39 cases showed that due to the morphological crossover with mucoepidermoid carcinoma and mucinous adenocarcinoma, and the atypical nature of the covered squamous epithelium was easily amplified in frozen section diagnosis, the misdiagnosis rate of PMSGP of tumor properties on frozen section is as high as 52.6%. Conclusions: PMSGP is a rare benign tumor of the lung, that has a high rate of misdiagnosis on frozen section. On frozen section, the tumor is well defined and has a papillary structure. The papilla is covered with squamous epithelium and glandular epithelium. Basal cells are arranged in a palisade pattern along the fibrovascular axis, and the cells are stratified without atypia. Mastering these characteristics helps to improve the diagnostic accuracy of frozen section.

参考文献

[1] Borczuk AC, Cooper WA, Dacic S, et al. WHO Classifica-tion of Tumours of Thoracic Tumours[M]. 5th ed, Lyon(France): International Agency for Research on Cancer, 2021:37-40.
[2] Flieder DB, Koss MN, Nicholson A, et al. Solitary pulmonary papillomas in adults: a clinicopathologic and in situ hybridization study of 14 cases combined with 27 cases in the literature[J]. Am J Surg Pathol, 1998, 22(11):1328-1342.
[3] Tryfon S, Dramba V, Zoglopitis F, et al. Solitary papillomas of the lower airways: epidemiological, clinical, and therapeutic data during a 22-year period and review of the literature[J]. J Thorac Oncol, 2012, 7(4):643-648.
[4] Noda N, Ebie Y, Matsumura M, et al. Comparison of detection specificity of nitrifying bacteria in biofilm using fluorescence in situ hybridization and in situ fluorescent antibody methods[J]. Water Sci Technol, 2003, 47(5):129-132.
[5] Li F, He M, Li F, et al. Histologic characteristics and prognosis of lung mixed squamous cell and glandular papilloma: six case reports[J]. Int J Clin Exp Pathol, 2019, 12(9):3542-3548.
[6] Lin DL, Xing XM, Ran WW, et al. Pulmonary peripheral glandular papilloma and mixed squamous cell and glandular papilloma frequently harbour the BRAF V600E mutation[J]. Histopathology, 2020, 76(7):997-1004.
[7] 汪小霞, 李锐, 冯潇, 等. 肺混合性鳞状细胞和腺性乳头状瘤临床病理学分析[J]. 中华病理学杂志, 2019, 48(4):318-321.
[7] Li R, Feng X, et al. Clinicopathological analysis of pulmonary mixed squamous cell and glandular papilloma[J]. Chin J Pathol, 2019, 48(4):318-321.
[8] Iijima Y, Nakajima Y, Kinoshita H, et al. Mixed squamous cell and glandular papilloma of the lung: a case report and literature review in Japan[J]. Int J Surg Case Rep, 2020, 68:39-42.
[9] Yun JS, Kim DW, Choi YD, et al. Mixed squamous cell and glandular papilloma of the lung in a 64-year-old woman[J]. Korean J Thorac Cardiovasc Surg, 2014, 47(1):55-58.
[10] Miyoshi R, Menju T, Yoshizawa A, et al. Expression of p16 Ink4a in mixed squamous cell and glandular papilloma of the lung[J]. Pathol Int, 2017, 67(6):306-310.
[11] Feng AN, Wu HY, Zhou Q, et al. Solitary endobronchial papillomas with false impression of malignant transformation: report of two cases and review of the literature[J]. Int J Clin Exp Pathol, 2015, 8(7):8607-8612.
[12] 刘荣美, 孟庆大. 肺混合性鳞状细胞和腺性乳头状瘤3例报道[J]. 诊断病理学杂志, 2018, 25(7):533-534.
[12] Meng QD. Pulmonary mixed squamous cell and glandular papilloma: a report of three cases[J]. Chin J Diagn Pathol, 2018, 25(7):533-534.
[13] Yabuki K, Matsuyama A, Obara K, et al. A unique case of a huge mixed squamous cell and glandular papilloma of non-endobronchial origin with a peripheral growth[J]. Respir Med Case Rep, 2018, 24:108-112.
[14] Huo Z, Wu H, Li J, et al. Primary pulmonary mucoepidermoid carcinoma: histopathological and moleculargenetic studies of 26 cases[J]. PLoS One, 2015, 10(11):e0143169.
[15] 王征, 王恩华, 刘东戈. 肺原发性黏液性上皮源性肿瘤的病理诊断与鉴别诊断[J]. 中华肿瘤杂志, 2017, 39(1):1-6.
[15] Wang Z, Wang EH, Liu DG. Pathological diagnosis and differential diagnosis for primary pulmonary mucinous epi-thelial tumors[J]. Chin J Oncol, 2017, 39(1):1-6.
[16] Chang JC, Montecalvo J, Borsu L, et al. Bronchiolar adenoma: expansion of the concept of ciliated muconodular papillary tumors with proposal for revised terminology based on morphologic, immunophenotypic, and genomic analysis of 25 cases[J]. Am J Surg Pathol, 2018, 42(8):1010-1026.
[17] Ishikawa Y. Ciliated muconodular papillary tumor of the peripheral lung: benign or malignant?[J]. Pathol Clin Med (Byouri-to-Rinsho), 2002,20,964-965.
[18] Kamata T, Sunami K, Yoshida A, et al. Frequent BRAF or EGFR mutations in ciliated muconodular papillary tumors of the lung[J]. J Thorac Oncol, 2016, 11(2):261-265.
[19] Liu L, Aesif SW, Kipp BR, et al. Ciliated muconodular papillary tumors of the lung can occur in western patients and show mutations in bRAF and AKT1[J]. Am J Surg Pathol, 2016, 40(12):1631-1636.
[20] Abe J, Ito S, Takahashi S, et al. Mixed squamous cell and glandular papilloma of the lung resembling early adenocarcinoma: A case report[J]. Ann Med Surg (Lond), 2016, 7:61-64.
[21] Sasaki E, Masago K, Fujita S, et al. AKT1 mutations in peripheral bronchiolar papilloma: glandular papilloma and mixed squamous cell and glandular papilloma is distinct from bronchiolar adenoma[J]. Am J Surg Pathol, 2021, 45(1):119-126.
[22] 陈晓炎, 杨晓群, 袁菲, 等. 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(5):575-580.
[22] Yang XQ, Yuan F, et al. Pulmonary ciliated muconodular papillary tumor: clinical pathologic analysis of two cases and review of literature[J]. J Diagn Concepts & Pract, 2018, 17(5):575-580.
[23] Popper HH, Wirnsberger G, Jüttner-Smolle FM, et al. The predictive value of human papilloma virus (HPV) typing in the prognosis of bronchial squamous cell papillomas[J]. Histopathology, 1992, 21(4):323-330.
[24] Huang YL, Chang YL, Chen KC, et al. Mixed squamous cell and glandular papilloma of the lung: a case report of a novel mutation in the BRAF gene and coexistent HPV infection, possible relationship to ciliated muconodular papillary tumor[J]. Pathol Int, 2019, 69(2):104-109.
[25] Inamura K, Kumasaka T, Furuta R, et al. Mixed squamous cell and glandular papilloma of the lung: a case study and literature review[J]. Pathol Int, 2011, 61(4):252-258.
[26] Tryfon S, Dramba V, Zoglopitis F, et al. Solitary papillomas of the lower airways: epidemiological, clinical, and therapeutic data during a 22-year period and review of the literature[J]. J Thorac Oncol, 2012, 7(4):643-648.
[27] Hayashi T, Tachibana S, Nakao K, et al. Solitary peripheral pulmonary squamous cell papilloma; diagnostic significance of 18F-fluorodeoxyglucose positron emission tomography findings[J]. Kyobu Geka, 2017, 70(4):309-312.
文章导航

/