CAJ | 학술논문

目的探讨伴微乳头结构(MPP)肺腺癌的临床病理特征和影像学特点.方法回顾性分析2011年7月至2012年12月手术切除的80例伴MPP肺腺癌患者的临床资料,分析其临床病理特征和影像学特点.结果 80例伴MPP的肺腺癌患者中,Ⅰ期38例(47.5％),Ⅱ期12例(15.0％),Ⅲ期25例(31.3％),Ⅳ期5例(6.2％).中分化14例(17.5％),中低分化66例(82.5％).有胸膜侵犯、脉管侵犯、支气管壁累及、大血管累及、神经侵犯和淋巴结转移其中之一者63例(78.8％).免疫组化结果显示,甲状腺转录因子1(TTT-1)和细胞角蛋白7(CK7)阳性率均为100％,表面活性剂载脂蛋白A(SPA)阳性率为84.0％.影像学检查结果显示,肺门或纵膈淋巴结肿大占18.8％,但病理确诊肺门或纵隔淋巴结转移者占45.0％.肺部影像以周围型为主,中央型较少,实性病灶多见,大部分伴分叶征、毛刺、胸膜凹陷征和血管集束征,磨玻璃影(GGO)和空泡征极少.结论伴MPP的肺腺癌早期就出现胸膜、血管、淋巴管和淋巴结浸润.影像学表现为周围型和实性病灶为主,多伴分叶征、毛刺征、胸膜凹陷征和血管集束征等,GGO和空泡征较少.TTF-1、CK7、SPA高表达和癌胚抗原升高与临床分期有关.
목적 탐토반미유두결구(MPP)폐선암적림상병리특정화영상학특점.방법 회고성분석2011년7월지2012년12월수술절제적80례반MPP폐선암환자적림상자료,분석기림상병리특정화영상학특점.결과 80례반MPP적폐선암환자중,Ⅰ기38례(47.5％),Ⅱ기12례(15.0％),Ⅲ기25례(31.3％),Ⅳ기5례(6.2％).중분화14례(17.5％),중저분화66례(82.5％).유흉막침범、맥관침범、지기관벽루급、대혈관루급、신경침범화림파결전이기중지일자63례(78.8％).면역조화결과현시,갑상선전록인자1(TTT-1)화세포각단백7(CK7)양성솔균위100％,표면활성제재지단백A(SPA)양성솔위84.0％.영상학검사결과현시,폐문혹종격림파결종대점18.8％,단병리학진폐문혹종격림파결전이자점45.0％.폐부영상이주위형위주,중앙형교소,실성병조다견,대부분반분협정、모자、흉막요함정화혈관집속정,마파리영(GGO)화공포정겁소.결론 반MPP적폐선암조기취출현흉막、혈관、림파관화림파결침윤.영상학표현위주위형화실성병조위주,다반분협정、모자정、흉막요함정화혈관집속정등,GGO화공포정교소.TTF-1、CK7、SPA고표체화암배항원승고여림상분기유관.
Objective To explore the clinicopathological characteristics and imaging features of lung adenocarcinoma with a micropapillary pattern (MPP).Methods Eighty cases of pulmonary adenocarcinoma with a micropapillary pattern treated in our hospital from July 2011 to December 2012 were selected to retrospectively analyze their clinicopathological characteristics and imaging features.Results Among the 80 cases of lung adenocarcinoma with MPP,there were 38 cases of stage Ⅰ (47.5％),12 cases of stage Ⅱ (15.0％),25 cases of stage Ⅲ (31.3％) and 5 cases of stage Ⅳ (6.2％).There were 14 cases of moderately differentiated (17.5％) and moderately/poorly differentiated (82.5％) tumors.Sixty-three cases had pleural involvement,vascular invasion,involving the bronchial wall,invasion of large vessels,nerve invasion,and lymph node metastasis (at least one of them) (78.8％).Immunohistochemical staining revealed that both positive rates of TTF-1 and CK7 were 100％,and that of pulmonary surfactant apolipoprotein-A (SPA) was 84.0％.Imaging examination revealed hilar or mediastinal lymph node enlargement in 15 cases (18.8％).but the pathology confirmed hilar or mediastinal lymph node metastasis in 36 cases (45.0％).Lung CT imaging showed that the majority of the cases were peripheral type,and only a few of central type,and most cases were solid lesions,with lobulation,spiculation,pleural indentation,and vascular convergence sign,while there were few ground-glass opacity sign and vacuole sign.Conclusions Lung adenocarcinoma with MPP component often presents with early invasions of pleura,blood vessels,lymphatic vessels,and lymph nodes.Imaging manifestation of this cancer mainly shows as peripheral and solid lesions,often with lobulation,spiculation,pleural indentation,vascular convergence sign,but GGO and vacuole signs are unusual.Overexpression of TTF-1,CK7 and SPA,and elevated CEA level are associated with clinical staging of the disease.