伴有浸润性微乳头状结构肺腺癌的病理诊断与预后

Pathologic diagnosis and prognosis of lung adenocarcinoma with a micropapillary pattern

目的:探讨伴有浸润性微乳头状结构肺腺癌的临床病理特点、诊断及预后。方法:回顾性分析4例伴有浸润性微乳头状结构的肺腺癌临床特点,光镜观察组织病理学形态及免疫组织化学特征,并复习相关文献。结果:伴有浸润性微乳头状结构的肺腺癌,临床表现为咳嗽、咳痰伴痰中带血,影像学发现肺部占位;组织学观察肿瘤组织中均可见比例不等的缺乏纤维血管轴心的游离乳头状细胞簇;免疫组织化学染色显示癌细胞上皮膜抗原、上皮性钙黏附蛋白、细胞凋亡抑制因子、甲状腺转录因子-1、细胞角蛋白7均为阳性,核增殖指数高表达,细胞角蛋白20、雌激素受体均为阴性。手术后平均随访2年,其中2例手术后6个月发现胸腔积液和腹腔积液,另2例术后存活,至今未见肯定远处转移。结论:伴有微乳头状结构肺腺癌中其微乳头状结构提示肿瘤的侵袭转移行为,是影响预后的重要因素。

Objective：To study the clinicopathologic characteristics,diagnosis and prognosis of lung adenocarcinoma with a micropapillary pattern（MPP）.Methods：Four cases of lung adenocarinoma with MPP were retrospectively analyzed.The pathological features and the immnunotype were observed by light microscopy,and the literature was reviewed.Results：The clinical manifestations of lung adenocarcinoma with MPP were cough,expectoration and bloody sputum.Imaging findings demonstrated masses in the lung.Microscopically,the tumors consisted of variable proportion of corpora mammillaria cell clusters devoid of a fibrovascular core.By immunohistochemical staining,the tumor cells showed positive epithelial membrane antigen,E-cadherin,thyroid transcription factor-1 and cytokeratin 7;antigen（Ki-67） was highly expressed.The expressions of cytokeratin 20 and estrogen receptor were negative.The follow-up was two years on the average.Two of the cases developed hydrothorax and ascites six months after the operation,and the other two cases survived up to now with no distant metastasis.Conclusions：The content of MPP suggests invasion and metastasis of lung adenocarcinoma with MPP,which is an important factor influencing the prognosis.