肺黏液表皮样癌12例临床病理分析

Clinicopathological features and differential diagnosis of primary lung mucoepidermoid carcinoma

目的探讨肺黏液表皮样癌(pulmonary mucoepidermoid carcinoma,PMC)临床与病理学特征、诊断与鉴别诊断、治疗及预后。方法对12例PMC进行组织形态学和免疫组织化学检查,结合文献复习进行分析并随访。结果 12例PMC中7例行支气管镜活检显示黏膜下肿物,呈息肉样突向管腔,部分表面可见破溃,界限较清。病理形态显示12例PMC均由黏液细胞、鳞状细胞和中间型细胞构成,细胞分化程度较高,PAS、AB-PAS染色阳性。免疫组化染色示肿瘤细胞CAM5.2、HCK和p63均(+),Ki-67增殖指数为10%左右。12例均行手术治疗,均未见淋巴结转移,随访其中10例均无复发或死亡。结论 PMC较少见,为低度恶性肿瘤。临床症状无特异性,容易误诊。支气管镜活检有助于早期诊断,手术切除预后较好。

Purpose To investigate the clinicopathological features,diagnosis and differential diagnosis,therapeutic principle and prognosis of primary pulmonary mucoepidermoid carcinoma.Methods Twelve cases of primary pulmonary mucoepidermoid carcinoma were studied from 2005~2010 in Shanghai Changhai Hospital.Results There were 6 males and 6 female with the median age of 39.75 years.Nine patients were admitted with respiratory symptoms such as cough,empsyxis,anhelation and dyspnea.Seven patients were checked by bronchoscope and showed submucousa mass as a polyp toward bronchial lumen.All patients were treated by operation.Microscopically,there were three types of tumor cells containing squamous cells,mucous cells and intermediate cells,Nine cases were low grade type of mucoepidermoid carcinoma.The staining of PAS and AB-PAS were positive.Immunohistochemistry showed the tumor cells was positive for CAM5.2,HCK,p63 and Ki-67（about 10%）.All patients were not detected lymph node metastasis and ten patients live without recurrence.Conclusions Primary pulmonary mucoepidermoid carcinoma is a rare,low-grade tumor.There are nonspecific symptoms and easily misdiagnosis.Bronchoscopic biopsy is good for early diagnosis.Operation is the effective treatment and the prognosis of this tumor is better.