肺黏液表皮样癌的CT大体分型和免疫组化特征研究

CT Gross Typing and Immunohistochemical Features of Pulmonary Mucoepidermoid Carcinoma

目的:探讨肺黏液表皮样癌的CT大体分型和免疫组化特征。方法:回顾性分析上海交通大学医学院附属新华医院2013年4月—2020年1月收治的8例肺黏液表皮样癌患者的临床、病理资料。结果:男5例,女3例,年龄11~80岁,中位年龄49岁。3例位于叶支气管,4例位于段支气管,1例位于肺的周围部。肿瘤最大径为1.0~7.0 cm,平均2.5 cm。腔内结节型2例,腔内外肿块型5例,外周型1例。8例平扫均为软组织密度,其中1例伴多发点状钙化。4例行CT增强扫描,呈轻度强化,2例伴阻塞性肺炎、肺不张,2例伴支气管黏液栓塞,1例伴支气管旁淋巴结肿大,1例伴左颈部淋巴结肿大。8例均行手术治疗,病理诊断为肺黏液表皮样癌,其中低级别6例,高级别1例,未定级别1例。免疫组织化学检查:8例CK5、P63表达阳性,6例CK7、P53表达阳性,3例EGFR表达阳性,6例Ki-67阳性率≤5%,8例Napsin A表达阴性,5例TTF1表达阴性,8例ALK表达阴性。结论:肺黏液表皮样癌早期易误诊,好发于叶、段支气管,CT大体分型以腔内外肿块型居多,边缘清楚,肿块长径与支气管走行一致,呈轻度强化,可合并阻塞性肺炎和肺不张,少有纵隔及肺门淋巴结转移。Napsin A、TTF1阴性表达,结合CK5、CK7、P63阳性表达有助于PMEC的诊断。

Purpose:To investigate the CT classification and immunohistochemical features of pulmonary mucoepidermoid carcinoma.Methods:A retrospective analysis was made on the clinical and pathological data of 8 patients with pulmonary mucoepidermoid carcinoma admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2013 to January 2020.Results:There were 5 males and 3 females,aged from 11 to 80 years,with a median age of 49 years.Three cases were located in lobar bronchus,4 cases in segmental bronchus,and 1 case in the periphery of lung.The maximum diameter of the tumor was 1.0-7.0 cm,with an average of 2.5 cm.There were 2 cases of intraluminal nodule type,5 cases of intraluminal and extraluminal mass type,and 1 case of peripheral type.All 8 cases showed soft tissue density on plain scan,including 1 case with multiple point calcification.Four cases showed slight enhancement on enhanced CT scan,including 2 cases with obstructive pneumonia and atelectasis,2 cases with bronchial mucus embolism,1 case with parabronchial lymph node enlargement,and 1 case with left cervical lymph node enlargement.All 8 cases were treated surgically.Pathological diagnosis was pulmonary mucoepidermoid carcinoma,including 6 cases of low grade,1 case of high grade and 1 case of undetermined grade.Immunohistochemical examination:CK5 and P63 were positive in 8 cases,CK7 and P53 were positive in 6 cases, EGFR was positive in 3 cases, Ki-67 positive rate ≤ 5% was in 6 cases, Napsin A wasnegative in 8 cases, TTF1 was negative in 5 cases, and ALK was negative in 8 cases. Conclusion: Pulmonarymucoepidermoid carcinoma is easy to be misdiagnosed in the early stage, which often occurs in the lobar andsegmental bronchus. The CT general classification is mostly intraluminal and extraluminal mass, with clear edges.The long diameter of the mass is consistent with the bronchial route, showing slight enhancement. It can be combinedwith obstructive pneumonia and atelectasis, and there are few mediastinal and hilar lymph node metastases. Negativeexpression of Napsin A and TTF1 combined with positive expression of CK5, CK7 and P63 is helpful for thediagnosis of pulmonary mucoepidermoid carcinoma.