Axiotis C A, Jennings T A
Department of Pathology, Albert Einstein College of Medicine, Bronx, New York 10461.
Am J Surg Pathol. 1988 Dec;12(12):918-31. doi: 10.1097/00000478-198812000-00003.
Pathological and clinical features in early localized mucinous and nonmucinous bronchiolo-alveolar carcinomas (BAC) have not been adequately compared. In an attempt to characterize such lesions, we studied the clinicopathological, ultrastructural, and immunohistochemical features of three mucinous and eight nonmucinous BAC (four Clara cell, four Type II pneumocyte) along with one sheep pulmonary carcinoma (SPC). Tumor border, associated fibroplasia, tumor cell incohesion, lymphocytic infiltrate, T-lymphocytes, Langerhans cells (LC), and Leu-M1 and OC 125 immunoreactivity were evaluated. Localized tumors of both types had a similarly favorable prognosis, even when the tumor size was greater than 3 cm or showed more complex histology. Type II pneumocyte carcinomas with tumor cell disassociation and desquamation or a pseudomesotheliomatous phenotype did poorly. Clara cell and type II carcinomas elicited an LC and T-lymphocyte immune response. LC and T-lymphocytes were absent in mucinous BAC and SPC. All of the three mucinous and three of the seven nonmucinous BAC were Leu-M1 negative, indicating that Leu-M1 may not distinguish between BAC and mesothelioma, especially in a small biopsy specimen. Tumors with absent or slight Leu-M1 immunoreactivity had a favorable outcome irrespective of cell type and presence or absence of LC. Inasmuch as OC 125 was negative in all cases of BAC, OC 125 may be a useful adjunct in the immunodiagnosis of mesothelioma. Our investigation supports the view that two different groups of tumors are assembled under the single nosologic entity of BAC: one, mucinous, which grows along an unaltered pulmonary alveolar framework and elicits a B-lymphocytic response, and the other, nonmucinous, which induces desmoplasia and elicits an LC and T-lymphocytic response. Only mucinous BAC represent a biologic entity distinct from conventional pulmonary adenocarcinomas.
早期局限性黏液性和非黏液性细支气管肺泡癌（BAC）的病理和临床特征尚未得到充分比较。为了对这类病变进行特征描述，我们研究了3例黏液性BAC和8例非黏液性BAC（4例Clara细胞型、4例II型肺泡细胞型）以及1例绵羊肺癌（SPC）的临床病理、超微结构和免疫组化特征。评估了肿瘤边界、相关的纤维组织增生、肿瘤细胞黏附性丧失、淋巴细胞浸润、T淋巴细胞、朗格汉斯细胞（LC）以及Leu-M1和OC 125免疫反应性。两种类型的局限性肿瘤预后相似，即便肿瘤大小大于3 cm或组织学表现更为复杂。具有肿瘤细胞解离和脱落或假间皮瘤表型的II型肺泡细胞癌预后较差。Clara细胞型和II型肺泡细胞癌引发LC和T淋巴细胞免疫反应。黏液性BAC和SPC中不存在LC和T淋巴细胞。3例黏液性BAC中的所有病例以及7例非黏液性BAC中的3例Leu-M1呈阴性，这表明Leu-M1可能无法区分BAC和间皮瘤，尤其是在小活检标本中。Leu-M1免疫反应性缺失或微弱的肿瘤，无论细胞类型以及LC是否存在，预后均良好。由于所有BAC病例中OC 125均为阴性，因此OC 125可能是间皮瘤免疫诊断中的一项有用辅助指标。我们的研究支持这样一种观点，即在BAC这一单一疾病分类实体下存在两组不同的肿瘤：一组为黏液性，沿未改变的肺泡框架生长并引发B淋巴细胞反应；另一组为非黏液性，诱导纤维组织增生并引发LC和T淋巴细胞反应。只有黏液性BAC代表一种不同于传统肺腺癌的生物学实体。
