Maeda Ryo, Isowa Noritaka, Onuma Hideyuki, Miura Hiroshi, Harada Tomoya, Touge Hirokazu, Tokuyasu Hirokazu, Kawasaki Yuji
Division of Thoracic Surgery, Matsue Red Cross Hospital, Matsue, Shimane, Japan.
Gen Thorac Cardiovasc Surg. 2009 Oct;57(10):534-9. doi: 10.1007/s11748-009-0436-y. Epub 2009 Oct 16.
Micropapillary adenocarcinoma is becoming increasingly recognized as a prognostically important histological subtype of carcinoma in various organs. This report presents the clinicopathological findings of lung adenocarcinomas with micropapillary components.
A total of 15 patients with micropapillary components were selected between April 2005 and December 2008. The results of their clinical presentation, metastasis to lymph nodes, pleural invasion, pathological stage, and clinical outcomes were evaluated.
In all, 12 patients underwent a lobectomy or bilobectomy with a regional lymph node dissection; 8 showed metastases to the regional lymph nodes at the time of the operation. Altogether, 14 of 15 cases showed lymphovascular invasion; 10 cases were up-staged after the operation because of lymph node metastases or pleural invasion. The duration of follow-up ranged from 1 to 42 months (median 16 months). Seven patients are alive without disease, whereas seven are alive with disease and one patient died of disease.
These results suggest that the micropapillary components are a manifestation of aggressive behavior, as shown by the frequent lymph node metastases and pleural invasion. Surgeons should search more carefully for metastases and conduct a closer follow-up on these patients when this feature is present with lung adenocarcinoma.
微乳头腺癌越来越被认为是各种器官中具有重要预后意义的癌组织学亚型。本报告介绍了具有微乳头成分的肺腺癌的临床病理特征。
选取2005年4月至2008年12月期间共15例具有微乳头成分的患者。评估其临床表现、淋巴结转移、胸膜侵犯、病理分期及临床结局。
12例患者接受了肺叶切除术或双肺叶切除术及区域淋巴结清扫术；8例在手术时出现区域淋巴结转移。15例中有14例出现脉管侵犯；10例因淋巴结转移或胸膜侵犯在术后分期上调。随访时间为1至42个月（中位时间16个月）。7例患者无病存活，7例带瘤存活，1例患者死于疾病。
这些结果表明，微乳头成分是侵袭性行为的一种表现，如频繁的淋巴结转移和胸膜侵犯所示。当肺腺癌出现此特征时，外科医生应更仔细地寻找转移灶，并对这些患者进行密切随访。
