穿刺活检标本中硬化性肺细胞瘤诊断分析

Histopathological diagnosis of pulmonary sclerosing pneumocytoma in needle biopsy specimens

目的:探讨穿刺活检标本中硬化性肺细胞瘤(pulmonary sclerosing pneumocytoma,PSP)的诊断线索,提高术前诊断正确率,避免误诊。方法:收集郑州大学第一附属医院2015年1月至2023年1月所有经手术切除并病理证实为PSP的穿刺活检标本79例,回顾性分析临床、病理及免疫组织化学特点。结果:79例患者中男性8例,女性71例,年龄14~67岁,中位年龄47岁。有5例术前误诊为腺癌,1例误诊为类癌,73例确诊为PSP,84.8%(67/79)患者胸部影像学显示边界清晰、质地均匀的单发性实体瘤。组织病理学显示:26.6%(21/79)以单一结构为主,67.1%(53/79)包含2种组织结构,6.3%(5/79)包含3种组织结构,未观察到同时包含4种结构的病例。肿瘤由表面立方细胞和间质圆形细胞构成,细胞形态温和,未见明确核分裂象。部分病例可见形态学变异:腺样结构(58.2%,46/79)、硬化性乳头(46.8%,37/79)、肿瘤细胞过度增生(16.5%,13/79)和细胞异型性(24.1%,19/79)。免疫组织化学:2种肿瘤细胞均表达甲状腺转录因子1、上皮细胞膜抗原、β-catenin;表面细胞表达广谱细胞角蛋白、Napsin A;间质细胞表达波形蛋白,部分病例表达雌激素受体、孕激素受体。结论:穿刺活检标本在诊断PSP时避免误诊的关键是识别肿瘤中的双细胞群,细胞性乳头、细胞温和且形态多样、背景出血及硬化明显、间质泡沫样细胞聚集时具有提示意义,同时结合特征性的免疫表型以及中年女性好发的特点有助于PSP的诊断。

Objective To investigate the diagnostic features of pulmonary sclerosing pneumocytoma(PsP)in needle biopsy specimens so as to improve the preoperative diagnostic accuracy and to prevent misdiagnoses.Methods A total of 79 needle biopsy cases confirmed as PSP in surgical resection specimens were collected in the First Affiliated Hospital of Zhengzhou University,Zhengzhou,China from January 2015 to January 2023.A retrospective analysis was conducted to investigate the clinical,pathological,and immunohistochemical characteristics of PsP.Results Among the 79 cases,there were 8 males and 71 females,with an age range of 14 to 67 years(median 47 years).Among the 79 needle biopsy cases of PSP,5 cases were initially misdiagnosed as adenocarcinoma and 1 as carcinoid preoperatively,while the remaining 73 cases were correctly diagnosed.84.8%(67/79)of the PSP presented with well-defined,homogeneous,solitary solid tumors on chest imaging.Morphologically,26.6%(21/79)of the PSP mainly showed a single histological component,67.1%(53/79)contained two histological components,and 6.3%(5/79)contained three histological components.There were no cases containing all four histological components simultaneously.The tumor was composed of cuboidal cells on the surface and round cells in the stroma and lacked significant cytological atypia and mitotic figures.Some cases exhibited variations in histology and cellular morphology,such as glandular spaces(58.2%,46/79),sclerotic papllae(46.8%,37/79),hypercellularity(16.5%,13/79),and cytological atypia(24.1%,19/79).Immunophenotyping indicated that both tumor cell types expressed TTF1,EMA andβ-catenin,while surface cells expressed pan-cytokeratin and Napsin A,and stromal cells expressed vimentin.In some cases,ER and PR were also expressed.Conclusions When diagnosing PSP in needle biopsy specimens,the key to avoiding misdiagnosis is recognizing the presence of dual-cell populations within the tumor.The useful clues include presence of cellular papillae,mild cellular atypia,morphological diversity,interstitial foam-like cell aggregates,and prominent background hemorrhage and sclerosis.The characteristic immunophenotypee and middle-aged female predilection are also helpful for the diagnosis of Psp.