Zhou Pengcheng, Yu Wei, Wang Li, Xia Qianming, Chen Keling
Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine.
Department of Pathology, Chengdu University of Traditional Chinese Medicine.
Medicine (Baltimore). 2020 Oct 30;99(44):e23066. doi: 10.1097/MD.0000000000023066.
Pulmonary papillary adenoma is extremely rare. The limited number of published articles describing pulmonary papillary adenoma emphasize that it is always detected by physical examination, is difficult to diagnose, and has malignant potential. To further expand our understanding of this disease, we report on 15 cases of pulmonary papillary adenoma diagnosed from 2013 to 2019 in our hospital.The clinical and pathological data of 15 cases of pulmonary papillary adenoma were collected from the medical record system of our hospital. All the clinical data were checked by 2 independent researchers. All pathology outcomes were independently reassessed by 2 pathologists. A review of the relevant literature was performed.Of 15 patients identified, 6 were men and 9 were women, and the average age at disease onset was 61.3 years. Chest computed tomography (CT) indicated pneumonia, an isolated nodule, bronchiectasis, a mass, ground glass opacity, and local interstitial fibrosis under the pleura. Thirteen cases had benign histopathology upon microscopy and immunohistochemistry examination: a papillary morphology, grade 2 or 3 papillary branches, and a slender nipple axis composed of fibers and vessels. More than 80% of the papillary epithelial cells were columnar or cubic, and single-layered or pseudostratified, with a round nucleus at the bottom of the cell. The cytoplasm was rich in mucus and neutral mucopolysaccharides. Except the above-mentioned features, there was also local epithelial dysplasia, carcinogenesis, and interstitial infiltration in two cases. The 2 patients with a cancerous mass underwent surgical resection, whereas the other patients were kept under surveillance. While one patient with cancer is deceased, follow-up indicates that the remaining patients have experienced a good outcome.Pulmonary papillary adenoma is very rare in clinical practice, and its clinical manifestations and CT images are not specific. Some cases may be cancerous and surgical resection should be the preferred treatment.
肺乳头状腺瘤极为罕见。为数不多的已发表文章描述了肺乳头状腺瘤，强调其总是通过体格检查发现，诊断困难，且具有恶变潜能。为进一步拓展我们对该疾病的认识，我们报告我院2013年至2019年诊断的15例肺乳头状腺瘤病例。从我院病历系统收集了15例肺乳头状腺瘤的临床和病理资料。所有临床资料由2名独立研究人员核查。所有病理结果由2名病理学家独立重新评估。并进行了相关文献回顾。在确诊的15例患者中，男性6例，女性9例，发病平均年龄为61.3岁。胸部计算机断层扫描（CT）显示有肺炎、孤立结节、支气管扩张、肿块、磨玻璃影及胸膜下局部间质纤维化。13例经显微镜检查和免疫组化检查显示为良性组织病理学特征：乳头状形态、2级或3级乳头状分支以及由纤维和血管组成的细长乳头轴心。超过80%的乳头状上皮细胞为柱状或立方状，单层或假复层，细胞核位于细胞底部呈圆形。细胞质富含黏液和中性黏多糖。除上述特征外，另有2例存在局部上皮发育异常、癌变及间质浸润。2例有癌性肿块的患者接受了手术切除，其余患者进行观察。其中1例癌症患者死亡，随访表明其余患者预后良好。肺乳头状腺瘤在临床实践中非常罕见，其临床表现和CT图像不具特异性。部分病例可能发生癌变，手术切除应作为首选治疗方法。
