Fukushima M, Fukuda Y, Kawamoto M, Yamanaka N
Department of Pathology, Nippon Medical School, Tokyo, Japan.
Pathol Int. 2000 Dec;50(12):1004-13.
Elastosis is the pathological finding of focal deposits of elastic fibers in abnormal amounts within tissue. It is well described in the case of infiltrating carcinoma of the breast, but elastosis in lung carcinoma has not been previously documented in detail. We investigated the characteristics of elastosis in lung carcinoma with light and electron microscopies, and immunohistochemistry for alpha-1-antitrypsin. A total of 184 surgically resected primary lung carcinomas were studied. Elastosis was detected in adenocarcinomas (85/106), squamous cell carcinomas (11/60) and adenosquamous carcinomas (5/7), but not in small-cell carcinomas (n = 4) or large-cell carcinomas (n = 5). The degree of elastosis in each case was divided into one of five grades, graded as 3+ to 1-. The score of elastosis was significantly higher in adenocarcinoma than that in squamous-cell carcinoma (P < 0.01). In the cases of adenocarcinoma, the mean score of elastosis in the well-differentiated type (WD n = 43) was higher than that in the moderately differentiated (MD) (n = 39; P = 0.012) and poorly differentiated (PD) types (n = 24; P < 0.01). The mean score of elastosis in MD adenocarcinoma was also higher than that in the PD type (P < 0.01). Light- and electron-microscopic analyses revealed that these elastic fibers in elastosis were composed of aggregates of thick mature and fine immature elastic fibers, and were positive for alpha-1-antitrypsin. It is suggested that both degraded elastic fibers and newly synthesized fibers are contained in the elastosis of lung carcinoma. Although no significant evidence was detected to suggest any correlation between elastosis and the degree of tumor invasion, the survival curves of adenocarcinomas with elastosis showed a significantly improved prognosis than of those without elastosis in the cases of stages IA and IB (n = 52; P = 0.026).
弹性组织变性是指组织内弹性纤维出现异常数量的局灶性沉积的病理表现。在乳腺浸润性癌中对此已有充分描述，但肺癌中的弹性组织变性此前尚未有详细记录。我们通过光学显微镜、电子显微镜以及α-1抗胰蛋白酶免疫组织化学方法研究了肺癌中弹性组织变性的特征。共研究了184例手术切除的原发性肺癌。在腺癌（85/106）、鳞状细胞癌（11/60）和腺鳞癌（5/7）中检测到弹性组织变性，但在小细胞癌（n = 4）或大细胞癌（n = 5）中未检测到。每例弹性组织变性的程度分为五个等级之一，从3+到1-分级。腺癌中弹性组织变性的评分显著高于鳞状细胞癌（P < 0.01）。在腺癌病例中，高分化型（WD，n = 43）的弹性组织变性平均评分高于中分化型（MD，n = 39；P = 0.012）和低分化型（PD，n = 24；P < 0.01）。MD腺癌的弹性组织变性平均评分也高于PD型（P < 0.01）。光学显微镜和电子显微镜分析显示，这些弹性组织变性中的弹性纤维由粗大成熟和细小不成熟弹性纤维的聚集体组成，且对α-1抗胰蛋白酶呈阳性。提示肺癌的弹性组织变性中既包含降解的弹性纤维，也包含新合成的纤维。虽然未检测到明显证据表明弹性组织变性与肿瘤浸润程度之间存在任何相关性，但在IA期和IB期（n = 52；P = 0.026）病例中，有弹性组织变性的腺癌的生存曲线显示预后明显优于无弹性组织变性的腺癌。
