Clinical Laboratory Division, Kanagawa Prefecture Cardiovascular and Respiratory Center, Yokohama, Japan.
Pathology Division, Kanagawa Prefecture Cardiovascular and Respiratory Center, Yokohama, Japan.
Cancer Cytopathol. 2023 Mar;131(3):198-206. doi: 10.1002/cncy.22666. Epub 2022 Dec 12.
The cytological features of interstitial pneumonia (IP)-related lung adenocarcinoma (LADC) have not been clearly described. This study aimed to describe its cytomorphological features, uncover potential problems in practical cytological diagnosis, and provide possible solutions.
Bronchial brushing cytology samples from 40 IP-related LADC cases (the IP group) and 110 control cases (LADC unrelated to IP; the non-IP group) were analyzed. All patients underwent surgery after brushing cytology, and their histopathological subtypes were determined. The authors reviewed the cytological features and focused particularly on cytoplasmic mucin production.
In the IP group, neoplastic cells with cytoplasmic mucin were detected at a significantly higher frequency (44.4% [8 of 18] vs. 6.3% [4 of 64]), and most of them were invasive mucinous adenocarcinomas (IMAs). Twenty-two of the 40 LADC cases in the IP group failed to be judged as "malignant/positive" (thus, they were judged to be "equivocal and/or negative"). The frequency of equivocal and/or negative judgments was 55.0% (22 of 40) in the IP group and 41.8% (46 of 110) in the non-IP group. The cytological diagnosis of IMA was difficult because it showed only slight nuclear atypia. Therefore, the authors examined the immunocytochemical expression of hepatocyte nuclear factor 4α (HNF4α), a diagnostic marker for IMA. As a result, four of the six cases that were judged to be equivocal in the IP group showed positive signals and could be retrospectively judged as malignant/positive.
The cytological diagnosis of IP-related LADC may be more difficult because of the larger proportion of IMA. Immunocytochemistry for HNF4α can be used to improve diagnostic confidence in IP-related LADC.
间质性肺炎（IP）相关肺腺癌（LADC）的细胞学特征尚未明确描述。本研究旨在描述其细胞形态学特征，揭示实际细胞学诊断中的潜在问题，并提供可能的解决方案。
分析了 40 例 IP 相关 LADC 病例（IP 组）和 110 例非 IP 相关 LADC 对照病例（非 IP 组）的支气管刷检细胞学样本。所有患者在刷检细胞学后均接受手术，并确定其组织病理学亚型。作者回顾了细胞学特征，特别关注细胞质黏蛋白的产生。
在 IP 组中，检测到具有细胞质黏蛋白的肿瘤细胞的频率明显更高（44.4%[18 例中的 8 例]与 6.3%[64 例中的 4 例]），其中大多数为浸润性黏液腺癌（IMA）。在 IP 组的 40 例 LADC 病例中，有 22 例未能被判断为“恶性/阳性”（因此，被判断为“可疑和/或阴性”）。IP 组的可疑和/或阴性判断频率为 55.0%（22 例中的 22 例），而非 IP 组为 41.8%（110 例中的 46 例）。IMA 的细胞学诊断较为困难，因为其仅显示轻微的核异型性。因此，作者检查了 HNF4α（IMA 的诊断标志物）的免疫细胞化学表达。结果，在 IP 组中被判断为可疑的 6 例中的 4 例显示阳性信号，可回顾性判断为恶性/阳性。
由于更大比例的 IMA，IP 相关 LADC 的细胞学诊断可能更为困难。HNF4α 的免疫细胞化学可用于提高对 IP 相关 LADC 的诊断信心。
