表现为肺部磨玻璃结节的浸润前病变和浸润性腺癌的CT及病理对比研究

A comparative study on computed tomographic and pathologic features between preinvasive lesions and invasive adenocarcinoma presented as pulmonary ground-glass opacity nodules

目的对肺部局灶性磨玻璃密度影(ground-glass opacity,GGO)患者CT影像和病理特征进行分析,以提高对GGO的认识。方法回顾性分析30例GGO患者,根据病理表现分为浸润前病变、微浸润性腺癌和浸润性腺癌,分析总结患者GGO的影像学表现对GGO病灶的病理切片行Masson染色、Ⅳ型胶原染色和维多利亚蓝染色,对比分析各组患者病理表现的差异以及病理与影像学特征的关系。结果 30例GGO患者中,浸润前病变13例,微浸润性腺癌3例,浸润性腺癌14例。磨玻璃结节中浸润前病变、微浸润性腺癌和浸润性腺癌的结节直径依次增大,实性成分依次增多,分叶、毛刺、支气管充气征等依次更多见;在血管集束征的肺结节与供血血管关系方面,浸润性腺癌多为Ⅲ型,浸润前病变多为Ⅱ型。Ⅳ型胶原染色和维多利亚蓝染色提示浸润性腺癌肿瘤组织中网状纤维和胶原纤维呈不同程度的缺失,而Masson染色可见浸润性腺癌胶原纤维增生且肺浸润癌中央可见纤维瘢痕。进一步分析病理与影像特征,结果提示肿瘤组织中有明显纤维瘢痕的患者的肺结节与供血血管的关系多为Ⅲ型。结论对于持续存在的GGO,病灶直径越大、实性成分越多,其恶性疾病可能性越大。在肿瘤逐步进展过程中,肿瘤细胞破坏肺泡壁周围网状纤维和胶原纤维,进一步浸润刺激成纤维细胞增生分泌胶原纤维,形成肿瘤组织中的纤维瘢痕,这可能为血管集束征形成的病理基础。

Objective To improve our recognition of ground-glass opacity （GGO） through analyzing the imaging and pathological features of patients with focal GGO lung nodule. Methods Thirty patients with focal GGO nodule were assigned into a preinvasive lesion group, a minimally invasive adenocarcinoma （MIA） group, and an invasive adenocarcinoma （IAC） group. The imaging features were retrospectively analyzed and pathological features by histological Masson staining, collagen Ⅳ staining and Vitoria blue staining were also compared among three groups. Furthermore, the relationship between pathology and imaging characteristics was studied too. Results Among 30 patients with focal GGO nodule, preinvasive lesions, MIA and IAC respectively occurred in 13, 3 and 14 cases. Size of nodules and solid portion were highest in the IAC group, middle in the MIA group, and lowest in the preinvasive lesion group. Similarly, signs of lobulation, spiculation and air bronchogram were seen mostly in the IAC group, and least in preinvasive lesion group. The spatial relationship between GGO nodules and supplying blood vessels was analyzed, and Type Ⅲ was more commonly seen in the IAC group with comparison to type Ⅱ more likely seen in the preinvasive lesion group. Moreover, collagen Ⅳ and Vitoria blue staining indicated that reticular fibers and collagenous fibers lessened around tumor tissue in the IAC group, whereas collagenous fibers proliferation and fibrous scar were shown by Masson staining in the IAC group. In CT-pathologic comparison, type Ⅲ supplying blood vessels were mostly seen in the IAC patients with obvious fibrous scar. Conclusions Persistent focal GGO nodules with larger size and higher percent of solid component are signs of malignancy. In tumor progression process, tumor cells break the reticular fibers and collagenous fibers in alveolar wall, then stimulate fibroblast hyperplasia and secrete collagenous fibers, thereby develop the central fibrous scar in tumor tissue, which might be the pathologic foundation of vascular bundle sign.