论著 Original Article

15例硬化性肺细胞瘤冰冻切片与临床病理特征分析

Published at: 2016年第36卷第12期

张小丽 1 , 赵强 1 , 马昕 1 , 兰智华 1 , 许春伟 2
1 南华大学附属第一医院病理科,湖南 衡阳 421000
2 福建省肿瘤医院病理科,福州 350014
通讯作者 强 赵 Email: 116806332@qq.com
DOI: 10.3978/j.issn.2095-6959.2016.12.014
基金:

摘要

目的:回顾性分析肺硬化性肺细胞瘤组织学及临床病理特点,提高快速冰冻诊断的准确性。方法:对15例经手术切除并诊断为硬化性肺细胞瘤的病例及2例冰冻误诊为硬化性肺细胞瘤的其他病变进行回顾性分析,包括冰冻及常规切片、免疫组织化学染色,结合临床病理特征进行总结。结果:本组15例硬化性肺细胞瘤,女性13例,平均年龄46岁;临床诊断肺癌6例,余9例为其他良性病变;冰冻切片诊断6例硬化性肺细胞瘤,1例炎性假瘤,1例错构瘤,2例肺癌,3例良性病变,2例延迟诊断;肿瘤常由乳头、硬化、实性、出血4种结构中的2种或多种混合而成。冰冻切片中10例见2种组织结构,4例见3种组织结构,1例见4种组织结构;圆形细胞TTF-1、EMA(+),表面上皮细胞TTF-1、EMA和CK(+),两种细胞Ki-67指数<2%。冰冻误诊为硬化性肺细胞瘤的2例,石蜡证实1例为混合亚型腺癌,1例为肺泡性腺瘤。结论:硬化性肺细胞瘤临床和影像学易误诊为癌,冰冻切片诊断准确率低。冰冻及石蜡切片中,常可见2种或2种以上组织结构;冰冻切片中以乳头状为主时,易误诊为腺癌;以实性为主时,易误诊为类癌。借助免疫组化指标,常可确诊。


Clinicopathological features of pulmonary sclerosing pneumocytoma: analysis of 15 cases in frozen and conventional diagnosis

Abstract

Objective: Retrospective analysis of pulmonary sclerosing pneumocytoma and clinical pathological features of the organization to improve the accuracy of frozen section diagnosis. Methods: Retrospectively analyzed 15 patients with surgically resected and diagnosed as pulmonary sclerosing pneumocytoma and 2 cases of frozen misdiagnosed as other lesions of pulmonary sclerosing pneumocytoma, including frozen and routine sectioning, immunohistochemical staining, summarized with clinical pathological features. Results: The group of 15 cases of pulmonary sclerosing pneumocytoma, 13 females, mean age 46 years; 6 cases of lung cancer, 9 cases of other benign lesions; frozen section diagnosis of 6 cases of pulmonary sclerosing pneumocytoma, 1 case of inflammatory pseudotumor, 1 case of hamartoma, 2 cases of lung cancer, 3 cases of benign lesions, 2 cases of delayed diagnosis; tumor were often mixed with two or more structures from the nipple, hardened, solid, and bleeding. In frozen sections, two kinds of organizational structure were found in 10 cases, three kinds of organizational structure in 4 cases, four kinds of organizational structure in 1 case; round cells TTF-1, EMA (+), the surface of epithelial cells TTF-1, EMA and CK (+), two cell Ki-67 index <2%. Two cases were frozen misdiagnosed as pulmonary sclerosing pneumocytoma, 1 case were confirmed as adenocarcinoma, 1 case as alveolar cell adenoma by paraffin. Conclusion: Pulmonary sclerosing pneumocytoma was easily misdiagnosed as cancer via clinical and radiographic data, the diagnostic accuracy of frozen sections is low. Frozen and paraffin sections often see two or more kinds of organizational structure; in frozen section, when papillary-based it may be misdiagnosed as adenocarcinoma; when solid-based it may be misdiagnosed as carcinoid. Combined with immunohistochemical indicators often can be diagnosed.


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引用

引用本文: 小丽 张, 强 赵, 昕 马, 智华 兰, 春伟 许. 15例硬化性肺细胞瘤冰冻切片与临床病理特征分析[J]. 临床与病理杂志, 2016, 36(12): 1965-1970.
Cite this article as: ZHANG Xiaoli, ZHAO Qiang, MA Xin, LAN Zhihua, XU Chunwei . Clinicopathological features of pulmonary sclerosing pneumocytoma: analysis of 15 cases in frozen and conventional diagnosis[J]. Journal of Clinical and Pathological Research, 2016, 36(12): 1965-1970.