Tomashefski J F, Connors A F, Rosenthal E S, Hsiue I L
Department of Pathology, Cleveland Metropolitan General Hospital, OH 44109.
Arch Pathol Lab Med. 1990 May;114(5):468-74.
We reviewed the clinical features and histopathologic findings of 21 peripheral pulmonary squamous cell carcinomas (SCC) resected at our institution between 1961 and 1981 and compared them with 19 central SCCs. Histologic features were scored semiquantitatively from 0 to 3+. Peripheral SCC represented 16% of all resected SCCs. The proportion of patients with multiple symptoms was lower and survival during the 5 years after surgery was better in the peripheral group. Tumor size, mitoses per high-power field (2.4 +/- 0.3 vs 4.1 +/- 0.6 [SEM]), prevalence of lymphatic invasion (19% vs 58%), and lymph node metastases (5% vs 37%) were lower, while chest wall invasion was more frequent (25% vs 0) for peripheral SCCs. Peripheral tumors also had more intense (2 or 3+) lymphoplasmacytic (86% vs 47%) and desmoplastic (95% vs 68%) reactions. Cox regression analysis did not support a significant relationship between tumor location and survival. We conclude that, compared with the central SCC, peripheral SCC is associated with fewer symptoms at presentation and better survival. Morphologically, peripheral SCCs are smaller, have fewer mitoses, less prevalent lymphatic invasion, and a more intense stromal reaction. Improved survival in patients with peripheral SCC may be due to a more favorable stage at the time of initial treatment.
我们回顾了1961年至1981年间在我院切除的21例周围型肺鳞状细胞癌（SCC）的临床特征和组织病理学表现，并与19例中央型SCC进行了比较。组织学特征采用半定量评分，从0至3+。周围型SCC占所有切除的SCC的16%。周围型组出现多种症状的患者比例较低，术后5年生存率较好。周围型SCC的肿瘤大小、每高倍视野的有丝分裂数（2.4±0.3对4.1±0.6[标准误]）、淋巴浸润发生率（19%对58%）和淋巴结转移率（5%对37%）较低，而胸壁侵犯更为常见（25%对0）。周围型肿瘤还具有更强烈（2或3+）的淋巴浆细胞反应（86%对47%）和促纤维组织增生反应（95%对68%）。Cox回归分析不支持肿瘤位置与生存之间存在显著关系。我们得出结论，与中央型SCC相比，周围型SCC在就诊时症状较少，生存率较高。形态学上，周围型SCC较小，有丝分裂较少，淋巴浸润较少见，且间质反应更强烈。周围型SCC患者生存率提高可能归因于初始治疗时分期更有利。
