摘要
目的分析细支气管腺瘤(bronchiolar adenoma,BA)患者的影像学表现和病理学特征。方法回顾性分析首都医科大学宣武医院2019年1月—2020年9月接受手术治疗的11例BA患者的临床资料,其中男5例、女6例,年龄40~73(62.40±10.50)岁。分析术前胸部CT的影像学特征、术中快速冰冻病理诊断情况、术后病理分型、细胞生长方式、细胞核增殖指数Ki-67等。结果平均术前观察时间(381.10±278.28)d,影像学病变最大径5~27(10.27±6.34)mm。表现为不规则形态的异质性磨玻璃样病变8例(72.7%),纯磨玻璃样病变3例(27.3%);有血管征象10例(90.9%),空泡征8例(72.7%),支气管征1例(9.1%),胸膜征3例(27.3%),毛刺/分叶征9例(81.8%)。术式包括亚肺叶切除10例和肺叶切除1例。术中冰冻病理明确诊断为BA的有5例(45.5%)。术后病理分型包括8例远端型BA和3例近端型BA,病灶最大径为4~20(8.18±5.06)mm。8例(72.7%)病灶在显微镜下可观察到特征性的双层细胞结构,10例(90.9%)病变组织显示甲状腺转录因子1表达;9例(81.8%)病灶显示NapsinA腔内细胞表达;病灶组织Ki-67指数为1%~5%(3.22%±1.72%)。结论病理学特征及影像学表现明确了BA是肿瘤性病变的前提,但对BA是良性或惰性肿瘤的认定,还需要更多的临床资料及分子病理学研究证据。
Objective To analyze the pathological manifestations and imaging characteristics of bronchiolar adenoma(BA).Methods The clinical data of 11 patients with BA who received surgeries in our hospital from January2019 to September 2020 were retrospectively analyzed,including 5 males and 6 females aged 40-73(62.40±10.50)years.The intraoperative rapid freezing pathological diagnosis,postoperative pathological classification,cell growth pattern,nuclear proliferation index Ki-67 and other immunohistochemical staining combined with preoperative chest CT imaging characteristics were analyzed.Results The average preoperative observation time was 381.10±278.28 d.The maximum diameter of imaging lesions was 5-27(10.27±6.34)mm.Eight(72.7%)patients presented with irregular morphology of heterogeneous ground-glass lesions,and 3(27.3%)patients presented with pure ground-glass lesions.There were 10(90.9%)patients with vascular signs,8(72.7%)patients with vacuolar signs,1(9.1%)patient with bronchus sign,3(27.3%)patients with pleural traction and 9(81.8%)patients with burr/lobular sign.The surgical methods included sub-lobectomy in 10 patients and lobectomy in 1 patient.Five(45.5%)patients were reported BA by intraoperative frozen pathology.The postoperative pathological classification included 8 patients with distal-type and 3 patients with proximal-type,and the maximum diameter of the lesions was 4-20(8.18±5.06)mm.Eight(72.7%)patients showed characteristic bilayer cell structure under microscope,and 10(90.9%)patients showed thyroid transcription factor 1 expression in pathological tissues.The expression of NapsinA in intracavity cells was found in 9(81.8%)patients.The Ki-67 index of the lesion tissue was 1%-5%(3.22%±1.72%).Conclusion The pathological features and imaging findings of BA confirm the premise that BA is a neoplastic lesion.However,to identify BA as a benign or inert tumor needs more clinical data and evidence of molecular pathological studies.
作者
苏雷
张毅
高艳
魏兵
王腾腾
李元博
钱坤
王雷明
魏秀芹
SU Lei;ZHANG Yi;GAO Yan;WEI Bing;WANG Tengteng;LI Yuanbo;QIAN Kun;WANG Leiming;WEI Xiuqin(Department of Thoracic Surgery,Xuanwu Hospital,Capital Medical University,Beijing,100053,P.R.China;Department of Radiology,Xuanwu Hospital,Capital Medical University,Beijing,100053,P.R.China;Department of Pulmonary and Critical Care Medicine,Xuanwu Hospital,Capital Medical University,Beijing,100053,P.R.China;Department of Pathology,Xuanwu Hospital,Capital Medical University,Beijing,100053,P.R.China;Endoscopic Center,Beijing Rehabilitation Hospital,Capital Medical University,Beijing,100144,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2023年第1期78-83,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
细支气管腺瘤
胸腔镜手术
影像学特征
术后病理
Bronchiolar adenoma
video-assisted thoracic surgery
imaging features
postoperative pathology
