肺微小脑膜上皮样结节CT表现与病理对照

目的：探讨肺微小脑膜上皮样结节（minute pulmonary meningothelial?like nodule，MPMN）的影像及病理表现，以提高对该病的认识和诊断水平。方法：回顾性分析2016—2017年经手术病理证实的37例MPMN影像学及病理学资料。结果：MPMN平均直径（1.7 ± 1.1）mm（范围0.5~5.0 mm）。16例MPMN是显微镜下病灶，CT图像上无明确显示。21例CT显示MPMN中，13例为多发病灶。21例MPMN均位于肺外周，19例为磨玻璃结节，17例病灶边界模糊，19例与肺小静脉相连。MPMN病理上表现为圆形、卵圆形或梭形脑膜上皮样细胞呈巢状散在分布，细胞含嗜酸性胞浆，染色质细腻，偶尔可见核内包涵体；病变沿胸膜下或肺小静脉分布，部分呈涡旋状排列。37例行免疫组化检查，波形蛋白（vimentin）表达均为阳性，30例孕激素受体（progesterone receptor，PR）表达阳性，32例上皮膜抗原（epithelial membrane antigen，EMA）表达阳性。结论：熟悉MPMN影像及病理学特点有助于提高诊断准确率，制定科学合理的治疗计划。

Minute pulmonary meningothelial-like nodule : CT features in comparison with pathological findings

Objective To investigate CT appearance and its pathological fundament of minute pulmonary meningothelial-like nodule (MPMN). Methods Thirty-seven cases of pathologically confirmed MPMN were retrospectively analysed with regard to CT features and pathological findings between 2016 and 2017. Results The median size of the MPMNs was 1.7±1.1 mm (range0.5-5.0mm) on pathological findings. Sixteen MPMNs (43.2%) were invisible on CT images. Among 21 CT-visible MPMNs, thirteen cases had more than one nodule. The nodules located in the peripheral lung (100%), presented as ground glass opacity (90.5%), had ill-defined margins (81.0%) and connected with small pulmonary vessels (90.5%). Microscopically, MPMNs appeared spindle cell nests with oval nuclei, finely granular chromatin, abundant granular and eosinophilic cytoplasm, and these nodules were typically juxtaposed to the pleura, and perilobular venous tributaries. By immunohistochemistry, strong reactivity to vimentin, progesterone receptor and epithelial membrane antigen of the nodules were noted in 37 cases,30 cases and 32 cases, respectively. Conclusion Knowledge of the CT findings and pathological features of MPMNs may help to improve diagnosis and achieve more appropriate treatment plan.