细支气管腺瘤24例临床病理分析

Clinicopathological analysis of 24 cases of bronchiolar adenoma

目的:探讨细支气管腺瘤(bronchiolar adenoma,BA)的发病年龄、部位、影像特征、临床表现、病理诊断、免疫表型及预后,提高临床医师对此病变的认识。方法:收集昆明医科大学第一附属医院病理科确诊的24例BA的临床资料,对其临床信息、影像特征、病理学特征及免疫表型等进行分析。结果:在24例BA中,男11例,女13例,平均发病年龄56.7岁,结节大小0.1~3.0 cm。21例为单发结节,3例为多发结节;17例为单独发生,7例伴发恶性肿瘤;20例为体检发现,另4例伴有轻微咳嗽、咳痰症状。胸部CT显示:有20例为单发或多发实性小结节、磨玻璃密度结节,2例为稍高密度影,1例斑片状影伴实变,1例囊性灶。典型的病理学特征为上皮细胞和连续性基底细胞形成的双层结构,上皮细胞形态为黏液性、乳头状、纤毛柱状或立方细胞。免疫组织化学显示:基底细胞表达P40、P63、细胞角蛋白(cytokeratin,CK)5/6、甲状腺转录因子-1(thyroid transcription factor-1,TTF-1)、腔面上皮细胞CK7、低分子角蛋白(CK-low,CKL)、天冬氨酸蛋白酶A(NapsinA)、TTF-1(均阳性)。结论:BA是发生于肺的少见良性肿瘤,影像学特征多为实性结节或磨玻璃结节,与早期恶性肿瘤难以鉴别。双层细胞结构与纤毛存在是BA与腺癌的主要鉴别点。

Objective:To investigate the age of onset,location,imaging features,clinical manifestations,pathological diagnosis,immunophenotype,and the prognosis of bronchiolar adenoma(BA),in order to improve clinicians’understanding of this disease.Methods:The clinical data of 24 patients with BA diagnosed in the Department of Pathology of the First Affiliated Hospital of Kunming Medical University were collected.The clinical information,imaging characteristics,pathological characteristics,and immunophenotype of BA were analyzed.Results:Among the 24 cases of BA,there were 11 males and 13 females.The average age of onset was 56.7 years.The size of the nodule was 0.1−3.0 cm.Twenty-one cases had single nodules and 3 cases had multiple nodules;17 cases occurred alone and 7 cases were accompanied by malignant tumors;20 cases were found by physical examination,and the other 4 cases were accompanied by mild cough and expectoration.Chest CT showed that 20 cases were single or multiple small solid nodules and ground glass density nodules,2 cases were slightly high-density shadows,1 case was a patchy shadow with consolidation,and 1 case was a cystic focus.The typical pathological feature was the double-layer structure formed by epithelial cells and continuous basal cells.The epithelial cells were mucinous,papillary,ciliated columnar or cubic cells.Immunohistochemistry showed that basal cells expressed P40,P63,cytokeratin(CK)5/6,and thyroid transcription factor-1(TTF-1),and luminal epithelial cells were positive for CK7,CK-low(CKL),NapsinA,and TTF-1.Conclusion:BA is a rare benign tumor occurring in the lung.Its imaging features are mostly solid nodules or ground-glass nodules,which are difficult to differentiate from early malignant tumors.The double cell structure and the existence of cilia are the main differential points between BA and adenocarcinoma.