肺混合性鳞状细胞腺性乳头状瘤2例临床病理分析并文献复习

Clinicopathological analysis of pulmonary mixed squamous cell and glandular papilloma

目的:探讨肺混合性鳞状细胞腺性乳头状瘤(MSCGP)的临床病理特点。方法:收集MSCGP 24例,其中某医院2例和文献报道22例,对其临床、影像、病理、免疫组化等特点进行分析总结。结果:24例中,平均年龄56.1岁。肿瘤主要位于支气管壁及肺实质细支气管内,影像学显示与支气管壁相连的息肉样肿物或肺实质内境界清楚的类圆形肿物。镜检,肿瘤内见富含纤维血管轴心的乳头状结构,表面被覆基底样细胞、鳞状细胞及腺上皮细胞(纤毛柱状上皮和粘液腺上皮),鳞状上皮细胞主要位于腺上皮的下方。上皮细胞形态温和,核分裂像罕见,无明显的坏死及浸润性依据。免疫组化,鳞状细胞及基底细胞表达p63及p40,腺上皮表达CK7、CEA及TTF-1,Ki-67增殖指数低。结论:MSCGP为主要发生于成人的罕见肺良性肿瘤,无明显性别差异,治疗主要以完整切除为主,由于病例较为罕见,加强病理学及免疫组化观察,避免出现误诊。

Objective:To study the clinicopathological features of pulmonary mixed squamous cell and glandular papilloma(MSCGP).Methods:24 MSCGPs were collected which including 2 cases diagnosed in our hospital and 22 cases reported in literatures.Results:A total of 24 patients,with a mean age of 56.1 years(17-76 years)。MSCGPs were mainly found in bronchus and peripheral lung bronchioles.The thoracic CT showed trachea polypus or rounded tumors with a distinct boundary in peripheral lung,some larger cases might reveal cystic degeneration.Papillary-like tumor styles were noted in most of the cases.The tumor was primarily composed of glandular epithelial cells(including mucinous glandular cells and ciliated columnar cells),squamous cells and basal cells.Immunohistochemistry indicated that the tumor was mostly positive for p63,p40,CK7,CEA,NapsinA and TTF-1.Ki-67 showed they have a very low proliferation rate.Conclusion:Knowledge on this disease is lacking.Therefore,the clinical and pathological characteristics of this tumor should be evaluated in detail in order to provide insight into subsequent diagnosis and treatment for clinicians and pathologists.