煤矽肺并发肺癌16例的尸检病理分析

目的 探讨煤矽肺并发肺癌的临床病理特点.方法 对16例生前诊断为尘肺0＋的煤尘接触工人并发肺癌者的尸检资料采用HE、组织化学、免疫组化染色进行回顾性分析.结果 16例患者均为男性,年龄46～57岁（平均52.8岁）,尸检肺内可见不同程度的煤尘沉积和煤尘纤维灶,煤矽结节检出率为93.75%（15/16）,15例病理诊断为Ⅰ期煤矽肺,1例为煤矽尘性反应;16例肺癌中鳞状细胞癌5例、小细胞未分化癌5例、肺泡细胞癌3例、腺癌2例、腺鳞癌1例.煤矽肺并发肺癌最明显的特点是癌组织位于煤尘纤维灶和纤维化病变旁或与尘肺病变混合存在.免疫组化结果除2例未分化癌表达神经源性标记外,余均表达上皮性标记物.波形蛋白可显示纤维成分.结论 部分肺癌的发生可能与纤维化病变有关.接尘工人可患与普通人群组织学类型相同的癌.PCNA和Ki67可作为预测患者预后的指标,波形蛋白可作为煤尘纤维灶中纤维成分的标记物.

A clinicopathological study of 16 autopsy cases of anthracosilicosis with lung cancer

Objective To investigate the clinicopathological characteristics of anthracosilicosis complicated with lung cancer. Methods Tissue specimens from 16 autopsy cases of 0+ anthracosilicosis complicated with lung cancer were retrospectively studied by hematoxylin-eosin,histochemical,and immunohistochemical staining. Results All of 16 patients were male.The patient's age ranged from 46 to 57 years(average:52.8 years).The dust-exposour time were over 25 years.The pneumoconiosis and dust fibrosis of different degrees in the lung were found.The positive detected rate of coal silicotic nodules was 93.75%(15/16).Among 16 cases of lung cancer,there were 5 cases of squamocell carcinoma,5 cases of small cell undifferentiated carcinoma,3 cases of bronchioloalveolar carcinoma,2 cases of adenocarcinoma,and 1 case of adenosquamous carcinoma.The typical pathological changes of anthracosilicosis complicated with lung cancer were:the cancer tissue was located at the side of coal dust fibrous focus and fibrosis lesion,or mixet with silicotic lesion.CK,EMA and CEA were positively expressed in most of the tumor cells,while vimentin was positive in the fibrocyte of dust fibrosis. Conclusions The occurrence of some lung cancer may be related with fibrosis.The dust-exposed workers can suffer from lung cancer which is histologically identical to the general lung tumor.PCNA and Ki67 may be a prognostic index for anthracosilicosis with lung cancer,while vimentin may be a marker for the examination of dust fibrosis in anthracosilicosis.