Kobzik L
Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115.
Semin Diagn Pathol. 1990 May;7(2):129-38.
Five benign pulmonary lesions that may be misdiagnosed as malignant tumors are reviewed. In three lesions, diagnostic problems arise when a spindle cell component is dominant and obscures other characteristic histologic features. In the inflammatory pseudotumor, correct diagnosis relies on recognition of the benign cytology of the spindle cells and identifying a typical admixture of plasma cell-rich inflammatory cells. For spindle cell carcinoids, useful diagnostic features are the organoid pattern, benign cytology, and neuroendocrine differentiation features of the spindle cells. Localized pleural mesothelioma (fibroma) is composed of benign spindle cells in a fibrocollagenous background; mesothelial differentiation is not present by ultrastructural or immunocytochemical analysis. In sclerosing hemangioma, a complex histology may suggest a number of malignancies. Observation of solid and papillary areas of benign tumor cells, as well as sclerosis of vessel walls and intervening areas, will allow correct diagnosis. Pseudolymphoma, a nodular benign lymphoid infiltrate, is distinguished by its polymorphous and polyclonal composition and numerous germinal centers.
本文回顾了五种可能被误诊为恶性肿瘤的良性肺病变。在三种病变中，当梭形细胞成分占主导并掩盖其他特征性组织学特征时，就会出现诊断问题。在炎性假瘤中，正确诊断依赖于认识到梭形细胞的良性细胞学特征，并识别富含浆细胞的炎性细胞的典型混合情况。对于梭形细胞类癌，有用的诊断特征是器官样结构、良性细胞学特征以及梭形细胞的神经内分泌分化特征。局限性胸膜间皮瘤（纤维瘤）由纤维胶原背景中的良性梭形细胞组成；超微结构或免疫细胞化学分析未显示间皮分化。在硬化性血管瘤中，复杂的组织学表现可能提示多种恶性肿瘤。观察良性肿瘤细胞的实性和乳头状区域，以及血管壁和中间区域的硬化，将有助于正确诊断。假淋巴瘤是一种结节性良性淋巴样浸润，其特征在于其多形性和多克隆组成以及众多生发中心。
