肺细支气管腺瘤5例临床病理观察并文献复习

Pulmonary bronchiolar adenoma:a clinicopathological analysis of five cases with review of literature

目的探讨肺细支气管腺瘤(bronchiolar adenoma,BA)的临床特征、组织病理学、免疫表型及鉴别诊断。方法收集潍坊医学院附属医院2020-08—2021-05收治的BA病例5例,分析病理学特征及免疫表型并文献复习。结果患者(男性2例,女性3例)主要为中老年人,仅1例有吸烟史,均无明显临床症状。影像学:肺外周实性结节(3例)、磨玻璃样结节影(2例)。巨检:实性结节,直径0.7~1.5 cm,界清无包膜。组织学:双层细支气管型上皮,多种细胞成分的腔面层和连续的单/多层基底细胞层。免疫组化:CK5/6、p63、p40在基底细胞呈连续阳性表达。随访6~18个月,均未见复发或转移。结论BA是罕见的良性肿瘤,影像及病理表现与癌相似,避免术中冷冻误诊对于外科处理很关键,结合典型的病理特征及免疫表型进行鉴别诊断。

Objective To investigate the clinical features,histopathology,immunophenotype and differential diagnosis of pulmonary bronchiolar adenoma(BA).Methods Five cases of BA from August 2020 to may 2021 in the Affiliated Hospital of Weifang Medical College were collected.The pathological characteristics and immunophenotype were analyzed and the literature was reviewed.Results The patients(2 males and 3 females)were mainly middle-aged and elderly people.Only one patient had a history of smoking and had no obvious clinical symptoms.Imaging showed peripheral solid nodules(3 cases)and ground glass-like nodule(2 cases).Grossly,solid nodule,0.7-1.5 cm in diameter,had clear boundary but no capsule.Histologically,double layer bronchiolar epithelia and luminal surface layer were noted with multiple cell components and continuous single/multi-layer basal cell layer.Immunohistochemically,the continuous positive expression of CK5/6,p63 and P40 in basal cells was the most important diagnostic basis.No recurrence or metastasis was found after 6~18 months of follow-up.Conclusion BA is a rare benign tumor.Its imaging and pathological manifestations are similar to those of cancer.Avoiding the misdiagnosis during intraoperative freezing section is key to surgical treatment.The differential diagnosis should be combined with typical pathological features and immunophenotype.