46例经纤维支气管镜活检诊断小细胞肺癌临床病理分析

Clinicopathological Analysis of 46 Cases of Small Cell Lung Cancer Diagnosed by Biopsy Via Fiberoptic Bronchoscopy

目的 探讨小细胞肺癌在纤维支气管镜下的形态学特征、临床表现、病理特征及免疫组化特点。方法 对46例经纤维支气管镜诊断小细胞肺癌患者临床病理资料、组织学改变及免疫组化结果进行回顾性研究并结合文献加以分析。结果 46例中男性33例,女性13例,年龄32~75岁,平均54岁。镜下肿瘤细胞较小,圆形、卵圆形及短梭形,胞质少,深染,易见核分裂。瘤细胞呈巢团状及梁索状排列。46例活检组织中均有程度不同的挤压变形,部分病例挤压严重者组织结构不清,易与肺的低分化鳞癌、腺癌、淋巴瘤及其它神经内分泌肿瘤混淆。免疫组化结果 CK、CD56、Syn100%阳性,TTF-197%阳性,Ki-67呈高增殖指数。结论 特征性组织形态学结合免疫组化结果有助于小细胞肺癌的诊断及鉴别诊断。上皮及神经内分泌标记物阳性表达、纤维支气管镜检查是临床早期发现,明确诊断小细胞肺癌的有效方法。

Objective To investigate the morphological characteristics via bronchof ibroscope, clinical manifestations, pathological and immunohistochemical features of small cell lung cancer. Methods The clinical data, histological changes and immunohistochemical results of 46 patients with small cell lung cancer diagnosed by biopsy of fiberoptic bronchoscopy were retrospectively analyzed and reviewed with literatures. Results Over- all 46 patients （33 men and 13 women）, aged from 32 to 75 years old （average 54 years old） were identified. Microscopically, the tumor cells were nest - like and string - like arrangement. These cancers were composed of tumor cells with a round to fusiform shape, scant cytoplasm, and finely granular chromatin. The cytological atypia and mitotic figures were frequently seen. The tumor ceils showed＂crush artifact＇in all the 46 biopsy speci- mens, the structure was especially unclear in some cases. Small cell lung cancer must be distinguished from poor- ly differentiated squamous cell carcinoma, adenoearcinoma, lymphoma and other neuroendoerine tumors of the lung. Immunohistochemically, the tumor cells showed completely positive for Cytokeratin（CK）, CD56, Synap- tophysin（Syn）, 97 % of the thyroid transcription factor 1 （TTF- 1 ） was positive, and the Ki - 67 index showed high proliferation. Conclusion The combination of characteristic morphology and immunohistochemistry panel is useful to the diagnosis and differential diagnosis of small cell lung cancer. Immunohistochemically, the tumor cells are positive for epithelial and neuroendocrine markers. Fiberoptic bronchoscopy is an effective method for early diagnosis of small cell lung cancer.