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肺纤毛黏液结节性乳头状肿瘤:术中检查的细胞学特征及诊断陷阱

Ciliated muconodular papillary tumors of the lung: Cytologic features and diagnostic pitfalls in intraoperative examinations.

作者信息

Mikubo Masashi, Maruyama Raito, Kakinuma Hirokuni, Yoshida Tsutomu, Satoh Yukitoshi

机构信息

Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.

Department of Pathology, Kitasato University Hospital, Kanagawa, Japan.

出版信息

Diagn Cytopathol. 2019 Jul;47(7):716-719. doi: 10.1002/dc.24169. Epub 2019 Mar 8.

Abstract

Ciliated muconodular papillary tumors (CMPTs) of the lung are rare, likely benign neoplastic lesions. Here we describe a case of a CMPT, focusing on its cytologic features, which to our knowledge have not been reported previously. Owing to dull back pain, a 69-year-old male non-smoker underwent CT, which revealed a 1.3 × 1.3-cm solid nodule in the peripheral field of the left lower lung lobe. A wedge resection of the nodule was performed, with the provisional diagnosis being primary lung cancer. Macroscopic examination of a resected specimen showed a 1.2-cm grayish nodule. Touch imprint smear cytology revealed ciliated columnar cells and mucous cells, as well as abundant extracellular mucin on inflammatory background of lymphocytes and histiocytes. Histologic examination revealed a nodular papillary tumor composed of ciliated columnar cells, mucous cells, and basal cells surrounded by a mucin pool. No nuclear atypia or mitotic figures were identified. The final diagnosis was CMPT. The postoperative course was uneventful, with no recurrence at 8 months after surgery. Although a CMPT is a rare lung tumor, it should be considered when cytological or histological examination of a solitary peripheral lung nodule shows non-atypical ciliated cells and mucous cells surrounded by mucin.

摘要

肺纤毛黏液结节性乳头状肿瘤(CMPT)较为罕见,可能是良性肿瘤性病变。在此,我们描述一例CMPT病例,重点关注其细胞学特征,据我们所知,此前尚未有相关报道。因背部钝痛,一名69岁的男性非吸烟者接受了CT检查,结果显示左肺下叶外周有一个1.3×1.3厘米的实性结节。对该结节进行了楔形切除术,初步诊断为原发性肺癌。对切除标本的宏观检查显示为一个1.2厘米的灰色结节。触摸印片涂片细胞学检查发现有纤毛柱状细胞和黏液细胞,以及在淋巴细胞和组织细胞炎症背景下大量的细胞外黏液。组织学检查显示为一个由纤毛柱状细胞、黏液细胞和基底细胞组成的结节状乳头状肿瘤,周围有黏液池。未发现核异型性或有丝分裂象。最终诊断为CMPT。术后病程平稳,术后8个月无复发。尽管CMPT是一种罕见的肺肿瘤,但当对孤立的外周肺结节进行细胞学或组织学检查显示非异型性纤毛细胞和被黏液包围的黏液细胞时,应考虑到这种肿瘤。

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