Abe Jiro, Ito Shigemi, Takahashi Satomi, Sato Ikuro, Tanaka Ryota, Sato Taku, Okazaki Toshimasa
Department of Thoracic Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiote, Natori, Miyagi, 981-1293, Japan.
Department of Pathology, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiote, Natori, Miyagi, 981-1293, Japan.
Ann Med Surg (Lond). 2016 Mar 23;7:61-4. doi: 10.1016/j.amsu.2016.03.025. eCollection 2016 May.
An extremely rare case of mixed squamous cell and glandular papilloma of the lung is reported. The correlation between the radiological and the pathological features as well as the clinical pitfall in making a diagnosis is discussed.
An asymptomatic 68-year-old female with a cigarette smoking habit presented with a small nodule in her peripheral lung. A wedge resection was performed though it failed on-site diagnosis which was instead obtained following pathological scrutiny. The postsurgical course was excellent with no recurrence of disease.
A small ground glass nodule gradually enlarged and transformed to a partially solid nodule a year and a half later. This transformation falsely made us suspect an early adenocarcinoma development. Eventually, the extremely rare subtype of pulmonary papilloma, with biphasic glandular and squamous cells, had been demonstrated to obstruct the peripheral bronchiole; and the adjoining alveoli had filled with a large volume of mucus. These pathological features seemed to have constituted the inner solid portion and the marginal ground glass portion respectively in the CT images, mimicking invasive lepidic adenocarcinoma.
Both pre- and intra-operative diagnoses are difficult mainly because of the rareness of the disease, however, mixed squamous cell and glandular papilloma may be considered in case the presence of primary adenocarcinoma is not validated.
报告了一例极为罕见的肺混合性鳞状细胞和腺性乳头状瘤病例。讨论了影像学特征与病理特征之间的相关性以及诊断过程中的临床陷阱。
一名68岁有吸烟习惯的无症状女性，其外周肺出现一个小结节。进行了楔形切除术，但术中诊断失败，术后经病理检查确诊。术后恢复良好，无疾病复发。
一个小的磨玻璃结节在一年半后逐渐增大并转变为部分实性结节。这种转变使我们错误地怀疑早期腺癌的发展。最终，经证实，这种极为罕见的肺乳头状瘤亚型具有双相腺细胞和鳞状细胞，阻塞了外周细支气管；相邻的肺泡充满了大量黏液。这些病理特征似乎分别构成了CT图像中的内部实性部分和边缘磨玻璃部分，酷似浸润性鳞屑样腺癌。
术前和术中诊断都很困难，主要是因为该疾病罕见，然而，如果原发性腺癌的存在未得到证实，则可考虑混合性鳞状细胞和腺性乳头状瘤。
