Abati A, Landucci D, Danner R L, Solomon D
Cytopathology Section, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892.
Hum Pathol. 1994 Mar;25(3):257-62. doi: 10.1016/0046-8177(94)90197-x.
Pulmonary microvascular tumor embolization is a recognized cause of respiratory distress in cancer patients that is rarely diagnosed antemortem. Previous studies with relatively few patients have reported high diagnostic yield using wedged pulmonary artery catheter-derived blood samples to evaluate dyspneic cancer patients for possible microembolization. From 1991 to 1993, 21 cancer patients with respiratory distress of relatively acute onset and varying severity who required pulmonary artery catheterization for hemodynamic monitoring were evaluated using this technique. Pulmonary microvascular cytology (PMC) was interpreted as positive for malignant cells in nine of 21 patients presenting with a range of tumor types, including carcinomas of the breast, colon, and pancreas as well as non-Hodgkin's lymphoma. In 11 patients the PMC was interpreted as negative. One case was considered nondiagnostic. Megakaryocytes, noted in most PMC specimens as well as in several samples of simultaneously drawn peripheral blood, may mimic epithelial tumor cells. Immunocytochemical stains for factor VIII and cytokeratins were used to resolve occasional diagnostic dilemmas. Clinical and/or pathologic follow-up information was available for all patients. Diagnostic accuracy was highest for epithelial malignancies. Two false-negative results occurred in patients with metastatic choriocarcinoma and breast carcinoma. Circulating malignant cells in the peripheral blood of a patient with non-Hodgkin's lymphoma led to one false-positive diagnosis. Benign lymphoid elements in PMC generally have a reactive and variable appearance that should not be misinterpreted as lymphoma. We conclude that PMC is a useful tool in the evaluation of dyspneic cancer patients requiring pulmonary artery catheterization for hemodynamic monitoring and its use potentially avoids additional diagnostic procedures.
肺微血管肿瘤栓塞是癌症患者呼吸窘迫的一个公认原因，生前很少被诊断出来。之前针对患者数量相对较少的研究报告称，使用楔入式肺动脉导管采集的血样来评估呼吸困难的癌症患者是否可能发生微栓塞，诊断阳性率很高。1991年至1993年，对21例因呼吸窘迫急性发作且严重程度各异而需要进行肺动脉导管插入术以进行血流动力学监测的癌症患者，采用了该技术进行评估。在21例呈现多种肿瘤类型（包括乳腺癌、结肠癌、胰腺癌以及非霍奇金淋巴瘤）的患者中，有9例的肺微血管细胞学检查（PMC）结果显示恶性细胞呈阳性。11例患者的PMC结果被判定为阴性。1例被认为无法诊断。在大多数PMC标本以及同时采集的几份外周血样本中都发现的巨核细胞，可能会模仿上皮肿瘤细胞。使用因子VIII和细胞角蛋白的免疫细胞化学染色来解决偶尔出现的诊断难题。所有患者均有临床和/或病理随访信息。上皮性恶性肿瘤的诊断准确性最高。转移性绒毛膜癌和乳腺癌患者出现了2例假阴性结果。1例非霍奇金淋巴瘤患者外周血中的循环恶性细胞导致了1例假阳性诊断。PMC中的良性淋巴样成分通常具有反应性且外观多变，不应被误诊为淋巴瘤。我们得出结论，PMC是评估因血流动力学监测需要进行肺动脉导管插入术的呼吸困难癌症患者的有用工具，使用它有可能避免额外的诊断程序。
