细支气管腺瘤15例临床病理学观察

Bronchiolar adenoma:a clinicopathological analysis of 15 cases

目的探讨细支气管腺瘤(bronchiolar adenoma)的临床病理特征、诊断及鉴别诊断。方法收集南京医科大学第一附属医院(江苏省人民医院)2016年1月至2019年10月共15例细支气管腺瘤病例,总结其临床资料、影像学检查、组织病理学特征、免疫组织化学表型及分子病理学改变。结果患者中男性3例,女性12例,女性多见,主要发生于中老年(51~77岁),3例有吸烟史。通常无临床症状,影像学表现为磨玻璃样、分叶状结节,大体示灰白、灰褐色的实性结节或局灶可见微囊样改变,多界清但无包膜,最大径0.4~2.5 cm(平均1.0 cm)。镜下可见腺腔型、乳头型及平坦型结构,细胞组成多样,可见数量不等的基底细胞、黏液细胞、纤毛细胞及肺泡上皮细胞,少数肿瘤可无黏液和/或纤毛细胞,部分肿瘤伴基底细胞增生或鳞化,免疫组织化学p63、p40、细胞角蛋白5/6显示连续的基底细胞层是其重要诊断依据。基因检测示BRAF和表皮生长因子受体(EGFR)基因均未见突变。随访1~41个月,所有患者均未见复发或转移。结论细支气管腺瘤是一种良性的肺外周肿瘤,由于认识不足,影像及病理均易误诊为恶性,明确诊断尤其是术中冷冻诊断对于外科处理非常关键,必要时可辅以免疫组织化学进行鉴别。

Objective To study the clinicopathological characteristics,diagnosis and differential diagnosis of bronchiolar adenoma(BA).Methods Fifteen cases of BA were collected from the First Affiliated Hospital of Nanjing Medical University,from January 2016 to October 2019.The clinical data,imaging examination,morphology,immunostaining and molecular changes were retrospectively analyzed.Results There were 3 males,12 females,most of the patients were female,mainly in middle-aged to elderly(51-77 years).Three had smoking history.The patients usually had no clinical symptoms.Imaging findings were ground-glass and/or lobulated nodules.Grossly,the tumors were gray-whitish,taupe solid or focally microcystic nodules with distinct boundary but no capsule.The maximum diameter was 0.4-2.5 cm(mean 1.0 cm).Histologically,there were glandular,papillary,or flat patterns that were composed of basal cells,mucous cells,ciliated cells and typeⅡpneumocytes,some of which showed basal cell proliferation and squamous cell metaplasia.However,there were some cases with few or even without mucous and/or ciliated cells.Immunostaining highlighted the continuous basal cell layer(positive for p63,p40 and cytokeratin 5/6),which was the most important diagnostic evidence.Genetic tests did not show mutation in BRAF or EGFR genes.All patients were followed up for 1-41 months,and they were without recurrence or metastasis.Conclusions BA is a benign neoplasm that develops in the peripheral lung with good prognosis.Definite diagnosis is very crucial for surgical treatment,especially in frozen consultation.Immunohistochemistry will be helpful if necessary.