肺纤毛黏液结节性乳头状肿瘤2例

<正>例1男性,64岁,体检发现右肺中叶结节10余天入院,CT示右肺中叶小结节直径约0.9 cm,边缘欠光整,见长短不一的小毛刺(图1);例2男性,70岁,体检发现右下肺微小结节3年余入院,CT示右肺下叶微小结节,直径约0.5 cm,随访3年未见明显变化(图2)。患者2009年行直肠癌根治切除术,随访未见复发。2例均完善相关检查后行胸腔镜下肺楔形切除术,标本均经10%中性福尔马林固定,石蜡包埋,常规4μm厚切片,HE染色,光镜观察。免疫组化     

肺纤毛黏液结节性乳头状肿瘤2例并文献复习

目的探讨肺纤毛黏液结节性乳头状肿瘤(ciliated muconodular papillary tumor, CMPT)的临床病理学特征、免疫表型、鉴别诊断及预后。方法回顾性分析2例肺CMPT的临床病理学资料,对肿瘤标本行常规HE和免疫组化EnVision两步法检测,并复习相关文献。结果 2例患者均为女性,年龄分别为62、70岁,均为体检时发现肺部肿块。肿瘤位于肺实质内,镜下见肿瘤由纤毛柱状细胞、黏液细胞和基底细胞3种成分组成,形成乳头状或腺管状结构,病变周围及内部肺泡腔内充满黏液。免疫表型:纤毛柱状细胞和黏液细胞CK7和TTF-1阳性,黏液细胞MUC6和MUC2阳性,基底细胞p63和TTF-1阳性。结论肺CMPT是一种罕见的肺外周结节性病变,确诊主要依赖特征性的病理学特征和免疫表型,患者预后较好。     

肺纤毛黏液结节性乳头状肿瘤2例并文献复习

目的探讨肺纤毛黏液结节性乳头状肿瘤(ciliated muconodular papillary tumors, CMPT)的临床病理学特征、诊断及预后。方法回顾性分析2例CMPT的临床病理学特征、免疫表型等并复习相关文献。结果例1女性,50岁;例2男性,41岁。2例均因发现肺部占位就诊,术后病理诊断为CMPT,其中例1同时患有微浸润性腺癌。镜下肿瘤由黏液细胞、纤毛柱状细胞及基底细胞混合组成的乳头状、腺管样结构,肺泡腔内可见黏液。细胞形态温和,无异型性,未见明显核分裂象及坏死。免疫表型:纤毛柱状细胞和黏液细胞表达CK7、TTF-1,不表达p63、p40、CK5/6、Napsin A;基底细胞表达TTF-1、CK7、p63、p40、CK5/6。结论 CMPT可能起源于终末细支气管,ERK活化状态和不同类型的驱动基因突变证实了CMPT是良性肿瘤性病变。识别纤毛柱状细胞及连续的基底细胞层是诊断CMPT的关键,需与黏液腺癌、黏液表皮样癌等鉴别。治疗以手术切除为主,预后良好。     

肺纤毛黏液结节性乳头状肿瘤5例临床病理分析

目的探讨肺纤毛黏液结节性乳头状肿瘤(ciliated muconodular papillary tumor, CMPT)的临床病理学特征、诊断及鉴别诊断。方法回顾性分析5例肺CMPT的临床病理、免疫表型、分子生物学特征及预后,并复习相关文献资料。结果患者年龄30～77岁(平均52岁),其中女性3例,男性2例,均为体检时发现肺外周部结节。眼观:肿瘤境界欠清。镜检:以基底细胞、纤毛柱状细胞和黏液细胞乳头状增生为主,可见少量腺管样结构及黏液湖形成。免疫表型:纤毛柱状细胞呈CK7、TTF-1阳性;基底细胞表达p63、p40及CK5/6;黏液细胞可弱阳性表达TTF-1和CK7;三类细胞Ki-67增殖指数均较低(1%～2%)。随访1～36个月(平均18个月)均未见肿瘤复发或转移。结论肺CMPT是罕见的肺原发良性/低度恶性潜能肿瘤,生物学行为惰性。在诊断工作中,特别是在术中快速冷冻诊断时极易与原发或继发肺黏液性腺癌相混淆。仔细寻找典型的CMPT形态学特点并辅以免疫组织化学染色有助于诊断和鉴别诊断。     

肺纤毛黏液结节性乳头状肿瘤二例北大核心CSCD

例1女,56岁。因腹部脂肪瘤术前检查,发现左侧肺部占位性病变于2015年11月19日入院,无发热寒战、喘息咳嗽等症状。     

多层螺旋CT导向经皮肺穿刺活检技术的探讨

目的探讨多层螺旋CT引导下经皮肺穿刺活检技术对肺部肿块进行诊断的临床应用价值．方法对86例肺部结节患者行多层螺旋CT引导下经皮肺穿刺活检，并进行病理检查及观察术后并发症．结果86例病例中病理证实恶性肿瘤52例，良性病变33例，1例未定性，确诊率为98．8％；并发气胸4例，咯血2例，并发症发生率为6．97％．结论多层螺旋CT引导下经皮肺穿刺活检技术具有定位准确，操作简单，安全性高，并发症少等优点，值得临床推广应用．     

儿童胰腺实性假乳头状瘤多排螺旋CT表现

目的:探讨儿童胰腺实性假乳头状瘤（SPTP）的多排螺旋CT（MDCT）表现。 方法:回顾性分析经手术病理证实为SPTP的10例患儿临床及MDCT资料,分析总结其特征表现。 结果:10例患儿均为女性,SPTP均为单发病灶,位于胰腺头颈部3例,胰腺体尾部7例。肿瘤最大径为2.5~13.8 cm,平均值为5.94 cm。8例呈类圆形,2例呈分叶状。10例均边界清晰,8例有完整包膜。平扫1例肿瘤呈均匀低密度,增强无明显强化;其余9例呈囊实性,8例以实性为主,1例囊实性比例相当,其中1例可见包膜下弧形钙化,实性成分动脉期呈轻度强化,强化程度低于正常胰腺组织,门脉期呈渐进性不均匀强化,囊性成分无强化。1例肿瘤出现肝内胆管和主胰管轻度扩张,1例出现主胰管轻度扩张。所有肿瘤均未见肝脏及淋巴结转移。 结论:儿童SPTP好发于女性,其CT表现具有一定的特征性,对诊断和鉴别诊断具有一定意义。     

Ciliated muconodular papillary tumor of the lung: A report of five cases

Ciliated muconodular papillary tumor (CMPT) of the lung is a newly defined and extremely rare tumor characterized by a papillary growth pattern, consisting of ciliated columnar cells, mucous cells, and basal cells with abundant mucin production. Tumor definitions and clinicopathological features continue to be debated. Herein, we report five surgical cases of CMPT to characterize its radiographic, gross, and microscopic features. The five cases involved three male patients aged 80, 67, and 66 years, and two female patients aged 73 and 70 years. Three cases were discovered during health care screenings, and two cases were found during follow‐up for another synchronous cancer. Histopathological examination revealed that the tumor tissue was composed of ciliated columnar cells, mucous cells, and basal cells with abundant mucin production. Neither nuclear atypia nor mitotic figures were observed. All patients had good prognoses. The benign histological features and clinical courses in these five cases suggest that CMPT is an independent and benign tumor of the lung.     

Clinicopathological characteristics and molecular analysis of lung cancer associated with ciliated muconodular papillary tumor/bronchiolar adenoma

Ciliated muconodular papillary tumor/bronchiolar adenoma (CMPT/BA) is a recently introduced benign lung tumor. It remains unclear whether CMPT/BA is associated with a specific type of lung cancer (LC). We studied the clinicopathological characteristics and genetic profiles of the coexisting primary LC and CMPT/BA (LCCM) cases. We identified eight LCCM (0.4%) from the resected Stage 0–III primary LC (n = 1945). The LCCM cohort was male-dominant (n = 8), elderly (median 72 years old), and most were smokers (n = 6). In addition to the adenocarcinoma (n = 8), we detected two squamous cell carcinomas and one small cell carcinoma—in some cases, multiple cancer. The target sequence/whole exome sequence (WES) revealed no shared mutations between CMPT/BA and LC. One exceptional case was invasive mucinous adenocarcinoma harboring an HRAS mutation (I46N, c.137T>A), but it was likely to be a single nucleotide polymorphism based on variant allele frequency (VAF). Other driver mutations in LC included EGFR (InDel, n = 2), BRAF(V600E) (n = 1), KRAS (n = 2), GNAS (n = 1), and TP53 (n = 2). BRAF(V600E) was the most frequent mutation in CMPT/BA (60%). In contrast, LC showed no specific trend in driver gene mutations. In conclusion, our study revealed differences in the gene mutation profiles of CMPT/BA and LC in coexisting cases, suggesting mostly independent clonal tumorigenesis of CMPT/BA from LC.     

Ciliated muconodular papillary tumors of the lung: Cytologic features and diagnostic pitfalls in intraoperative examinations

Ciliated muconodular papillary tumors (CMPTs) of the lung are rare, likely benign neoplastic lesions. Here we describe a case of a CMPT, focusing on its cytologic features, which to our knowledge have not been reported previously. Owing to dull back pain, a 69‐year‐old male non‐smoker underwent CT, which revealed a 1.3 × 1.3‐cm solid nodule in the peripheral field of the left lower lung lobe. A wedge resection of the nodule was performed, with the provisional diagnosis being primary lung cancer. Macroscopic examination of a resected specimen showed a 1.2‐cm grayish nodule. Touch imprint smear cytology revealed ciliated columnar cells and mucous cells, as well as abundant extracellular mucin on inflammatory background of lymphocytes and histiocytes. Histologic examination revealed a nodular papillary tumor composed of ciliated columnar cells, mucous cells, and basal cells surrounded by a mucin pool. No nuclear atypia or mitotic figures were identified. The final diagnosis was CMPT. The postoperative course was uneventful, with no recurrence at 8 months after surgery. Although a CMPT is a rare lung tumor, it should be considered when cytological or histological examination of a solitary peripheral lung nodule shows non‐atypical ciliated cells and mucous cells surrounded by mucin.     

Ciliated muconodular papillary tumor of the lung: A newly defined peripheral pulmonary tumor with conspicuous mucin pool mimicking colloid adenocarcinoma: A case report and review of literature

We report the case of a 68‐year‐old man with a newly defined rare entity of a peripheral pulmonary tumor, consisting of a nodular papillary lesion with papillary structures containing ciliated columnar and goblet cells, as well as floating tumor cells in the mucin pool. The conspicuous mucin pool was observed to be mimicking colloid adenocarcinoma in a low‐power view, particularly in a frozen section slide. We originally reported it as an adenocarcinoma during intraoperative consultation. Immunohistochemically, the tumor cells exhibited a similar immunophenotype to pulmonary adenocarcinoma, except for the presence of focal ciliated and basaloid cells, which we found using CK5/6 and P63 immunostaining. No KRAS or EGFR mutation was found. We revised the diagnosis to that of a ciliated muconodular papillary tumor (CMPT). Four years after a wedge resection, the patient remained free of tumors. Although the malignant potential of CMPT cannot be ignored, a wedge resection with a safe margin might be a treatment option for CMPT patients.     

胸部炎性肌纤维母细胞瘤的CT及MRI评价

目的 探讨胸部炎性肌纤维母细胞瘤(IMT)的CT和MRI表现,提高其影像学诊断水平.方法 回顾性分析2005年2月至2009年11月广州医学院第一附属医院及中山大学附属肿瘤医院住院并经手术病理证实的13例胸部IMT的影像学表现.结果 13例病灶中,肺5例,纵膈2例,食道上段1例,右侧胸壁2例,左侧胸壁2例,气管1例.肺IMT 1例为中央型,4例为周围型,为边缘清楚或不清的单发肿块.肺外IMT均表现为大小不一的单个实性软组织肿块,密度均匀或不均匀.2例病灶内出现斑点状钙化,1例胸壁IMT伴肋骨破坏.MR表现为T1WI呈稍低信号,T2WI呈不均匀高信号.结论 CT、MRI检查可清晰显示IMT的大小、形态及与周围组织的关系,对选择手术方案及评价治疗效果有重要参考价值.     

多排螺旋CT在诊断骨巨细胞瘤中的应用

目的探讨多排螺旋CT在诊断骨巨细胞瘤中的应用价值。方法回顾性分析11例经手术及病理证实的骨巨细胞瘤的CT影像表现。将64排CT扫描的原始轴住图像传至ADW工作站，采用容积再现（VR）多平面重建（MPR）技术处理图像。结果VR三维重建对病变的定位和空间关系理解更直观、立体、准确，MPR对病灶细节显示满意，可以多平面观察骨的密度、形态、大小变化及发现邻近软组织改变。结论多排螺旋CT在诊断骨巨细胞瘤中有重要应用价值，对临床手术方案的选择具有重大的指导意义。