肺原发性黏液腺癌临床病理观察

目的 探讨肺原发性黏液腺癌的临床病理特点、鉴别诊断和预后。方法 对1例肺原发性黏液腺癌进行组织形态学、免疫组织化学分析，并复习相关文献。结果 肺原发性黏液腺癌常见于成年人，病变主要分布于肺的外周部。形态学表现为分化好的黏液性上皮性病灶，上皮细胞立方或柱状，核位于基底部，胞质透亮呈分泌状态，亦可增生呈2～3层，中度异型，部分核大深染，核分裂象罕见，组织形态类似卵巢交界性黏液性囊腺瘤或胃肠道黏液腺癌结构，冷冻切片诊断易误诊为良性黏液性囊腺瘤。结论 肺原发性黏液腺癌是肺变异型腺癌中罕见的恶性肿瘤，形态特征与乳腺黏液腺癌相似，冷冻切片常难以做出可靠的病理诊断，要与肺黏液性囊腺瘤、黏液性细支气管肺泡癌、肺黏液性囊腺癌等鉴别。诊断主要是依赖病理形态学特点及免疫组化，预后相对较好，不同于胃肠道黏液腺癌。

Primary lung mucinous adenocarcinoma: a clinicopathologic observation

Objective To investigate the pathologic features, differential diagnosis and prognosis of primary lung mucinous adenocarcinoma. Methods A case of primary lung mucinous adenocarcinoma was studied by histology and immunohistochemistry and review of the literature. Results Primary lung mucinous adenocarcinoma usually occured in adult, most located in peripheral part of the lung. Its histological features were mucous epithelium, cuboidal or pillar epithelium with nucleus in the base, clear cytoplasm in secretory slate, and the epithelial proliferation to 2 or 3 layers with middle dysplasia. Some of the nucleus were big and heavy stained, but mitotic figures were rare. The histomorphology was similar to borderline mucinous cystadenoma of ovary and mucinous adenocarcinoma of gastrointestinal tract. It was easily misdiagnozed as begin mucinous eystadenoma in frozen section. Conclusions Primary lung mucinous adenocarcinoma is a rare type in lung adenoeareinoma. Its histomorphology is similar to breast mucinous adenocareinoma. It is very difficult to diagnose in frozen section. It should be differentiated from lung benign mucinous cystadenoma, mucinous bronchioloalveolar carcinoma and lung mucinous cystadenocareinoma. Correct diagnosis is depended on histolomorphology and immunohistochemistry. Its prognosis is better than that of mucinous adenocarcinoma in gastrointestinal tract.