肺癌前病变的病理形态

目的：观察和分析肺鳞状上皮不典型增生/原位癌（SD/CIS）的病理形态特点,为肺癌前病变的早期临床诊断提供依据。方法：收集360例手术切除的肺癌和肺炎性大体标本,HE染色,显微镜下寻找各级增生病变,观察和分析SD/CIS的病理形态特点。结果：肺癌组轻、中度不典型增生病变的发生率为23.9％（55/230）、重度不典型增生/原位癌34.8％（80/230）;在肺炎性组,轻度不典型增生病变的发生率为9.2％（12/130）,无一例中、重度不典型增生/原位癌病变。54.4％（80/147）的鳞状上皮不典型增生病变覆盖原有的支气管上皮细胞。SD/CIS的生长方式有两种,86.3％（69/80）为“蔓延型“生长,16.3％（13/80）为“假浸润型“生长。结论：SD/CIS主要存在于肺癌旁的各级支气管上皮。支气管上皮的SD/CIS不同于食管和宫颈等部位的癌前病变。依据WHO的分类标准,难以将覆盖支气管上皮的SD/CIS分级。实践中可以忽略覆盖在不典型增生病变之上的呼吸道上皮,只考虑鳞状上皮不典型增生病变,将SD/CIS分为“低级“和“高级“两种病变。

Pathomorphology of pulmonary preinvasive neoplasia

Objective To observe morphological changesof pulmonary squamous dysplasia and carcinoma in situ (SD/CIS) to provide objective criteria for earlier clinical diagnosis. Methods A total of 360 lung resection specimens from patients with lung cancer and pneumonia were collected. By HE staining, squamous dysplasia/CIS in those specimens were observed microscopically. Results In cancer group, 23.9%(55/230) of the specimens had mild-moderate atypia,and 34.8%(80/230) was severe. In pneumonia group, only 9.2%(12/130)had mild dysplasia, and there was no moderate and severe. About 54.4%(80/147)dysplasia was surmounted by differentiated respiratory glandular epithelium. SD/CIShad two growth pattern. Most cases (86.3%) were classified as the "creeping type" whose dominant growth pattern was a horizontal spread within the mucosa. Theremainder seemed to have a predominantly transmural rather than longitudinal growth pattern (penetrating type). Conclusion SD/CIS mainly exists in specimens from patients with lung cancer. Pulmonary SD/CIS is not similar to that in othersites such as the cervix or oesophagus. WHO criteria for assessing dysplasia assume a full thickness squamous epithelium,so grading of dysplasia in this partially transformed epithelium is difficult. The experience is to ignore the overlying respiratory epithelium and attempt to grade the squamouslayer as only a "low" or "high" grade.