Gao H, Du X L, Chen C N, Song G X, Gu Y L, Li H X
Department of Pathology, the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) , Nanjing 210029, China.
Zhonghua Bing Li Xue Za Zhi. 2020 Jun 8;49(6):556-561. doi: 10.3760/cma.j.cn112151-20191125-00755.
To study the clinicopathological characteristics, diagnosis and differential diagnosis of bronchiolar adenoma (BA). Fifteen cases of BA were collected from the First Affiliated Hospital of Nanjing Medical University, from January 2016 to October 2019. The clinical data, imaging examination, morphology, immunostaining and molecular changes were retrospectively analyzed. There were 3 males, 12 females, most of the patients were female, mainly in middle-aged to elderly (51-77 years). Three had smoking history. The patients usually had no clinical symptoms. Imaging findings were ground-glass and/or lobulated nodules. Grossly, the tumors were gray-whitish, taupe solid or focally microcystic nodules with distinct boundary but no capsule. The maximum diameter was 0.4-2.5 cm (mean 1.0 cm). Histologically, there were glandular, papillary, or flat patterns that were composed of basal cells, mucous cells, ciliated cells and type Ⅱ pneumocytes, some of which showed basal cell proliferation and squamous cell metaplasia. However, there were some cases with few or even without mucous and/or ciliated cells. Immunostaining highlighted the continuous basal cell layer (positive for p63, p40 and cytokeratin 5/6), which was the most important diagnostic evidence. Genetic tests did not show mutation in BRAF or EGFR genes. All patients were followed up for 1-41 months, and they were without recurrence or metastasis. BA is a benign neoplasm that develops in the peripheral lung with good prognosis. Definite diagnosis is very crucial for surgical treatment, especially in frozen consultation. Immunohistochemistry will be helpful if necessary.
研究细支气管腺瘤(BA)的临床病理特征、诊断及鉴别诊断。收集2016年1月至2019年10月南京医科大学第一附属医院的15例BA病例。对其临床资料、影像学检查、形态学、免疫组化及分子改变进行回顾性分析。男性3例,女性12例,多数患者为女性,主要为中老年(51 - 77岁)。3例有吸烟史。患者通常无临床症状。影像学表现为磨玻璃和/或分叶状结节。大体上,肿瘤为灰白色、灰褐色实性或局灶微囊性结节,边界清晰但无包膜。最大直径为0.4 - 2.5 cm(平均1.0 cm)。组织学上,有由基底细胞、黏液细胞、纤毛细胞和Ⅱ型肺泡上皮细胞组成的腺管、乳头或扁平模式,部分表现为基底细胞增生和鳞状化生。然而,部分病例黏液和/或纤毛细胞很少甚至没有。免疫组化显示连续的基底细胞层(p63、p40和细胞角蛋白5/6阳性),这是最重要的诊断依据。基因检测未显示BRAF或EGFR基因有突变。所有患者随访1 - 41个月,均无复发或转移。BA是一种发生于肺外周的良性肿瘤,预后良好。明确诊断对手术治疗至关重要,尤其是在冰冻切片会诊时。必要时免疫组化会有帮助。