Liu Shuli, Liu Nan, Xiao Mingming, Wang Liang, Wang En-Hua
Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University.
Department of Pathology, the People's Hospital of Liaoning Province, Shenyang, China.
Medicine (Baltimore). 2020 Sep 25;99(39):e22322. doi: 10.1097/MD.0000000000022322.
Bronchiolar adenoma (BA) is a newly designated rare entity of the lung, including both the currently designated ciliated muconodular papillary tumor (CMPT) and so-called non-classic CMPT. The most prominent histological feature of BAs is the bilayered cell structures composed of the continuous basal cell layer and the luminal layer which consists of different proportion of mucinous cells, ciliated cells, Clara cells and/or type II pneumocytes. BA purely covered by mucinous cells without other components in the luminal layer has never been reported.
An 82-year-old female patient was detected a 0.8 cm ground glass nodule in the left lower lobe of the lung.
The serum levels of tumor markers were normal.
The patient underwent a segmentectomy of the left lower lobe.
The postoperative pathological diagnosis was BA. Molecular analysis revealed that the tumor harbored ALK rearrangement and BRAF mutations simultaneously. There was no recurrence in 17 months of follow-up.
BA can be lined only by mucinous cells, without any cuboidal and/or ciliated cells in the surface layer. This sets a dangerous pitfall in differentiation diagnosis with invasive mucinous adenocarcinoma especially during intraoperative frozen pathological diagnosis.
细支气管腺瘤（BA）是一种新定义的罕见肺部病变，包括目前定义的纤毛黏液结节状乳头状瘤（CMPT）和所谓的非典型CMPT。BA最显著的组织学特征是由连续的基底细胞层和管腔层组成的双层细胞结构，管腔层由不同比例的黏液细胞、纤毛细胞、克拉拉细胞和/或II型肺泡上皮细胞组成。从未有过管腔层仅由黏液细胞覆盖而无其他成分的BA报道。
一名82岁女性患者在左肺下叶发现一个0.8 cm的磨玻璃结节。
肿瘤标志物血清水平正常。
患者接受了左肺下叶切除术。
术后病理诊断为BA。分子分析显示肿瘤同时存在ALK重排和BRAF突变。随访17个月无复发。
BA可仅由黏液细胞衬覆，表层无任何立方状和/或纤毛细胞。这在与浸润性黏液腺癌的鉴别诊断中，尤其是术中冰冻病理诊断时，构成了一个危险的陷阱。
