Ding Bowen, Shang Zhanxian, Xiang Zhenzhen, Han Yuchen
Department of Pathology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Am J Surg Pathol. 2023 Apr 1;47(4):431-439. doi: 10.1097/PAS.0000000000002016. Epub 2023 Feb 7.
To describe the histologic features of bronchiolar adenoma/ciliated muconodular papillary tumors (BA/CMPTs) and analyze the pitfalls in diagnosis from frozen sections. A total of 208 frozen and permanent sections of BA/CMPTs from Shanghai Chest Hospital from July 2018 to July 2021 were retrospectively analyzed. The median age of BA/CMPT patients was 65 years (15 to 79 y), and women accounted for 61.62% (122/198). The median size of BA/CMPTs was 0.6 cm (range 0.2 to 2 cm), of which 88.94% were small (≤1 cm, 185/208). In terms of location, the right lower lobe accounted for 44.23% (92/208), and the left lower lobe accounted for 33.65% (70/208). In 10 patients with 2 independent BA/CMPTs, 5 lesions were located in the left lower lobe and 4 in the right lower lobe. A total of 86.06% of the CT images of BA/CMPT showed solid/subsolid nodules (179/208). Among 208 tumors, 68.75% were distal type (143/208), and 31.25% were proximal type (65/208). The qualitative error rate of frozen sections was 21.33% (32/150), of which the distal type accounted for 75% (24/32); most of them were misdiagnosed as invasive adenocarcinoma during frozen diagnosis. The frozen diagnosis of BA/CMPTs might result in misdiagnosis as invasive adenocarcinoma. A careful search for characteristics of BA/CMPT, such as bilayer epithelial cells with basal cells and a lack of cellular atypia and invasive growth patterns, may be helpful for frozen diagnosis.
描述细支气管腺瘤/纤毛黏液结节状乳头状肿瘤（BA/CMPTs）的组织学特征，并分析冰冻切片诊断中的陷阱。回顾性分析了2018年7月至2021年7月上海胸科医院208例BA/CMPTs的冰冻切片和石蜡切片。BA/CMPT患者的中位年龄为65岁（15至79岁），女性占61.62%（122/198）。BA/CMPTs的中位大小为0.6cm（范围0.2至2cm），其中88.94%为小肿瘤（≤1cm，185/208）。就位置而言，右下叶占44.23%（92/208），左下叶占33.65%（70/208）。在10例有2个独立BA/CMPTs的患者中，5个病灶位于左下叶，4个位于右下叶。BA/CMPT的CT图像中共有86.06%显示实性/亚实性结节（179/208）。在208个肿瘤中，68.75%为远端型（143/208），31.25%为近端型（65/208）。冰冻切片的定性错误率为21.33%（32/150），其中远端型占75%（24/32）；大多数在冰冻诊断时被误诊为浸润性腺癌。BA/CMPTs的冰冻诊断可能会误诊为浸润性腺癌。仔细寻找BA/CMPT的特征，如具有基底细胞的双层上皮细胞、缺乏细胞异型性和浸润性生长模式，可能有助于冰冻诊断。
