肺原发性脑膜瘤2例临床病理观察

Primary pulmonary meningioma: a clinicopathologic study of two cases

目的探讨肺原发性脑膜瘤的临床病理学特征、诊断与鉴别诊断、治疗及预后。方法通过组织形态学观察及免疫组化方法对2例肺原发性脑膜瘤进行病理分析,并复习相关文献。结果 2例发生部位分别为左肺上叶和右肺下叶,年龄分别为35岁和68岁。肿瘤均为灰白色实体肿瘤,边界清楚;镜下肿瘤均由上皮样细胞和梭形细胞构成,出现漩涡状结构,细胞无明显异型;上皮样细胞核仁细小,染色质细;梭形细胞长梭形或略肥胖;肿瘤均无明显出血、坏死,局部出现砂砾体。免疫组化vimentin均(+),2例中1例EMA(+),另1例EMA局灶(+);而TTF-1、Napsin A、CK7、p40、p63、CK5/6、Syn、Cg A、CD34、SMA、Desmin、bcl-2、CD99、ALK均(-)。结论肺原发性脑膜瘤非常罕见,大多数为良性,依据病理形态学和免疫组织化学可以明确诊断,鉴别诊断首先要除外转移性脑膜瘤,手术完全切除是首选的治疗方式。

Objective To investigate the clinical and pathological features,diagnosis and differential diagnosis,treatment and prognosis of primary pulmonary meningioma. Methods Two cases of primary pulmonary meningioma were studied with routine morphological observation and immunohistochemical staining, and related literatures were also reviewed. Results Tumors were found in superior lobe of left lung and inferior lobe of right lung;one patient was35-year-old,and another was 68-year-old. Grossly,the tumors were depicted as solid and well-demarcated with grey-white appearance. Microscopically,the tumor cells were spindle and epithelioid,and had a whorled architecture,without cellular atypia. The epithelioid cells had fine chromatin,with tiny nucleoli. Spindle cells were long-spindle or slightly fat. No evidence of hemorrhage and necrosis was seen,and locally the psammoma bodies were appeared. The immunohistochemistry showed that the tumors were positive for vimentin,one of 2 cases was positive for EMA,another case was focal positivity for EMA,staining of tumor cells for TTF-1,Napsin A,CK7,P40,P63,CK5/6,Syn,Cg A,CD34,SMA,Desmin,Bcl-2,CD99 and ALK was negative. Conclusion The primary pulmonary meningioma is very rare,most of them are benign;diagnosis is based on its pathological morphology and immunohistochemistry,The first step in differential diagnosis is to exclude metastatic meningiomas;a complete surgical resection is the preferred way of treatment.