伴有浸润性微乳头结构肺腺癌的病理诊断及预后评价

目的探讨伴有微乳头结构肺腺癌的临床病理学特点、免疫表型特征及其侵袭行为对预后的影响。方法收集清远市人民医院2001年1月至2011年12月间具有完整临床病理及随访资料结果的伴有浸润性微乳头结构的肺腺癌13例,分析其临床病理学特点、免疫组化特征及预后。结果伴有浸润性微乳头结构的肺腺癌,临床表现为咳嗽、痰中带血、胸痛,影像学发现肺部占位现象;组织学观察肿瘤组织中均可见比例不等的缺乏纤维血管轴心的乳头状细胞簇,与肺泡壁连接或分离,瘤细胞可形成环样（ring-like）腺样结构;免疫组化染色显示癌细胞上皮膜抗原（EMA）、上皮性钙黏附蛋白（E-cadherin）、β-连接蛋白（β-catenin）、甲状腺转录因子-1（TTF-1）、细胞角蛋白7（CK7）均为阳性,核增殖指数（Ki-67）高表达。预后：手术后平均随访16.2个月,其中4例患者术后生存至今,未发现肿瘤（4/13,30.8%）;8例患者死于肿瘤（8/13,46.2%）;3例患者带瘤生存（3/13,23.1%）。结论肺腺癌中微乳头结构成分提示肿瘤高侵袭转移行为,是影响预后的重要因素,该病理形态的出现应在报告中列出,并注明百分比,提醒临床采取积极治疗措施并密切随访。

Pathologic Diagnosis and Prognosis of Lung Adenocarcinoma with a Micropapillary Pattern

Objective To study the clinicopathologic characteristics,immunohistochemical features and its invasion of influence on the prognosis of lung adenocarcinoma with a micropapillary pattern（MPP）.Methods Thirteen cases of lung adenocarcinoma with the results of complete clinicopathologic and follow-up data associated with infiltration of micropapillary pattern in Qingyuan People＇s Hospital from January 2001 to December 2011,were collected to analyze the clinicopathologic characteristics,immunohistochemical features and prognosis.Results The clinical manifestations of lung adenocarcinoma with MPP were cough,bloody sputum,chest pain,radiographic findings of lung placeholder phenomenon;histological observation of tumor tissue were visible proportion,ranging from lack of fibrovascular axis of papillary cell clusters,and alveolar wall connection or separation,tumor cells might form ring-like adenoid structure;immunohistochemical staining showed positive tumor cells epithelial membrane antigen,E-cadherin,β-catenin,thyroid transcription factor-1 and cytokeratin 7;antigen（Ki-67） was highly expressed.Prognosis：postoperative average follow-up was 16.2 months,4 patients were alive without tumor（4/13,30.8%）;8 patients died of tumor（8/13,46.2%）;3 patients were survival with tumor（3/13,23.1%）.Conclusions MPP in primary pulmonary adenocarcinoma,even when only constituting a minor component,predicts an aggressive clinical behavior and is associated with poor prognosis,the pathological form should be listed in the report with indication of the percentage,to alert clinicians of active treatment and close follow-up.