Elson C E, Moore S P, Johnston W W
Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710.
Anal Quant Cytol Histol. 1989 Aug;11(4):261-74.
Between 1968 and 1986, the tumor registries at Duke University Medical Center and Durham VA Medical Center accumulated a total of 193 patients with a diagnosis of bronchioloalveolar carcinoma (BAC). All available histologic sections of primary lung tumors and all available respiratory and pleural cytologic material were reviewed for 135 cases having an initial histologic diagnosis of BAC and no history of a primary nonpulmonary adenocarcinoma. Thirty-nine cases showed a pure BAC pattern in histologic sections; 76 showed a dominant BAC pattern with focal areas of fibrosis and acinar differentiation; 16 were carcinomas with a focal BAC pattern; and 4 were adenocarcinomas lacking a BAC pattern. Of the 115 cases with at least a dominant BAC pattern, 51 showed predominantly mucinous differentiation while 64 showed predominantly nonmucinous differentiation. Adequate cytologic material was available for review from 111 patients. For cases having at least a dominant BAC pattern, tumor cells were present in 77 of 172 adequate sputums (44.8%), 36 of 133 bronchoscopy specimens (27.1%), 15 of 18 needle aspirates (83.3%) and 14 of 15 pleural fluids (93.3%). Of all patients in this group, 60.2% had at least one specimen positive for malignancy. No cytologic features clearly distinguished adenocarcinomas having only focal bronchioloalveolar differentiation from those with a pure or dominant BAC pattern. A significant degree of overlap was observed in the cytologic features of mucinous and nonmucinous tumors. Histologic sections from 19 mucinous and 16 nonmucinous tumors were stained with monoclonal antibody B72.3: all showed some staining, with no significant difference in degree of staining between the two groups. This suggests that expression of the tumor-associated glycoprotein TAG-72 is independent of mucinous differentiation.
1968年至1986年间，杜克大学医学中心和达勒姆退伍军人事务医疗中心的肿瘤登记处共积累了193例细支气管肺泡癌（BAC）诊断病例。对135例最初组织学诊断为BAC且无原发性非肺腺癌病史的病例，复查了所有可用的原发性肺肿瘤组织切片以及所有可用的呼吸道和胸膜细胞学材料。39例在组织学切片中显示为纯BAC模式；76例显示为主导BAC模式并伴有局灶性纤维化和腺泡分化区域；16例为具有局灶性BAC模式的癌；4例为缺乏BAC模式的腺癌。在115例至少具有主导BAC模式的病例中，51例主要表现为黏液性分化，而64例主要表现为非黏液性分化。111例患者有足够的细胞学材料可供复查。对于至少具有主导BAC模式的病例，172份合格痰液中有77份（44.8%）存在肿瘤细胞，133份支气管镜检查标本中有36份（27.1%），18份针吸标本中有15份（83.3%），15份胸液中有14份（93.3%）。该组所有患者中，60.2%至少有一份标本恶性阳性。没有细胞学特征能明确区分仅具有局灶性细支气管肺泡分化的腺癌与具有纯或主导BAC模式的腺癌。在黏液性和非黏液性肿瘤的细胞学特征中观察到了显著程度的重叠。对19例黏液性肿瘤和16例非黏液性肿瘤的组织切片用单克隆抗体B72.3染色：所有切片均显示有一些染色，两组之间染色程度无显著差异。这表明肿瘤相关糖蛋白TAG - 72的表达与黏液性分化无关。
