BACKGROUND Bronchiolar adenoma(BA)and ciliated muconodular papillary tumor are rare tumors that have bilayered cell proliferation and continuous expression of p40 and CK5/6 in the basal cell layer.Diagnosis is difficu...BACKGROUND Bronchiolar adenoma(BA)and ciliated muconodular papillary tumor are rare tumors that have bilayered cell proliferation and continuous expression of p40 and CK5/6 in the basal cell layer.Diagnosis is difficult because of the limited knowledge of these tumors and their morphological similarities to malignant tumors,including invasive mucinous adenocarcinoma,especially based on the histopathology of intraoperative frozen sections.These tumors are now considered to be benign neoplasms,with malignant transformation reported in only a few cases.CASE SUMMARY A 57-year-old woman presented with a 17.0 mm×7.0 mm nodule in the lower lobe of the left lung.Hematoxylin-eosin staining and immunohistochemistry of a surgical specimen were performed.The tumor consisted of a BA area and a mucinous adenocarcinoma(MA)area.In the BA area,the tumor had a bilayered structure of luminal cells and basal cells.The basal cells were positive for CK5/6 and p40,but the MA area was negative for these biomarkers.The Ki-67 proliferation index was low(1%-2%).The patient was diagnosed with BA accompanied by MA,and had a favorable outcome.CONCLUSION The present study indicated that BA may be carcinogenic,and suggests that clinicians should be aware of its potential for malignant transformation.展开更多
BACKGROUND The clinicopathological features,immunohistochemical characteristics,and genetic mutation profile of two unusual cases of distal bronchiolar adenoma are retrospectively analyzed and the relevant literature ...BACKGROUND The clinicopathological features,immunohistochemical characteristics,and genetic mutation profile of two unusual cases of distal bronchiolar adenoma are retrospectively analyzed and the relevant literature is reviewed.CASE SUMMARY Case 1 was a 63-year-old female patient who had a mixed ground-glass nodule,with mild cells in morphology,visible cilia,and bilayer structures in focal areas.Immunohistochemical staining for P63 and cytokeratin(CK)5/6 revealed the lack of a continuous bilayer structure in most areas,and no mutations were found in epidermal growth factor receptor,anaplastic lymphoma kinase,ROS1,Kirsten rat sarcoma,PIK3CA,BRAF,human epidermal growth factor receptor-2(HER2),RET,and neuroblastoma RAS genes.Case 2 was a 58-year-old female patient who presented with a solid nodule,in which most cells were observed to be medium sized,the nuclear chromatin was pale and homogeneous,local cells had atypia,and cilia were found locally.Immunohistochemical staining for P63 and CK5/6 showed no expression of these proteins in mild cell morphology whereas the heteromorphic cells showed a bilayer structure.The same nine genes as above were analyzed,and HER2 gene mutation was identified.CONCLUSION Some unresolved questions remain to be answered to determine whether the lesion is a benign adenoma or a part of the process of malignant transformation from benign adenoma of the bronchial epithelium.Furthermore,whether lesions with atypical bilayer structures are similar to atypical hyperplastic lesions of the breast remains to be elucidated.Moreover,clarity on whether these lesions can be called atypical bronchiolar adenoma and whether they are invasive precursor lesions is needed.Future studies should examine the diagnostic significance of HER2 gene mutation as a prognostic indicator.展开更多
背景与目的肺纤毛黏液结节性乳头状肿瘤(ciliated muconodular papillary tumor of the lung,CMPT)的发病极其少见,在临床上与其他肺部病变亦难以区别,易造成误诊、漏诊;通过收集CMPT的资料,分析其临床病理特征,可以为广大医务工作者提...背景与目的肺纤毛黏液结节性乳头状肿瘤(ciliated muconodular papillary tumor of the lung,CMPT)的发病极其少见,在临床上与其他肺部病变亦难以区别,易造成误诊、漏诊;通过收集CMPT的资料,分析其临床病理特征,可以为广大医务工作者提供诊治思路,减少医疗差错。方法回顾性分析1例典型的CMPT患者的临床资料、病理特征、免疫表型并结合相关文献进行探讨。结果患者胸部计算机断层扫描(computed tomography,CT)提示右下肺近胸膜处可见混合密度结节影,直径约9 mm,肿瘤行肺楔形切除术,镜下见结节由增生的纤毛细胞、黏液细胞及基底样细胞混合组成,以乳头状、腺样结构为主,纤毛细胞衬覆于乳头状结构表面,基底样细胞位于外层,黏液细胞则位于两者之间,各种细胞异型不明显。免疫组化:上皮细胞CEA(+)、CK7(+)、CA125(+)、TTF-1(弱+)、CK20(-)、Ki67(1%+)、CK5/6(+);基底细胞P63(+)。结论CMPT是一种新近发现的罕见的肺部肿瘤,关于其良恶性目前尚无定论,但多数学者倾向于良性,其在影像学上可表现出诸多恶性肿瘤征象而常被误认为是肺腺癌,通过其典型的病理组织学特点及免疫组化表型可与其他肺部疾病进行鉴别,基因突变是否是其驱动因素目前尚不得知,该肿瘤行手术切除预后较好。展开更多
基金Supported by the Science and Technology Plan Project of Wenzhou,China,No.Y20190117the Natural Science Foundation of Zhejiang Province,China,No.LQ21H090017。
文摘BACKGROUND Bronchiolar adenoma(BA)and ciliated muconodular papillary tumor are rare tumors that have bilayered cell proliferation and continuous expression of p40 and CK5/6 in the basal cell layer.Diagnosis is difficult because of the limited knowledge of these tumors and their morphological similarities to malignant tumors,including invasive mucinous adenocarcinoma,especially based on the histopathology of intraoperative frozen sections.These tumors are now considered to be benign neoplasms,with malignant transformation reported in only a few cases.CASE SUMMARY A 57-year-old woman presented with a 17.0 mm×7.0 mm nodule in the lower lobe of the left lung.Hematoxylin-eosin staining and immunohistochemistry of a surgical specimen were performed.The tumor consisted of a BA area and a mucinous adenocarcinoma(MA)area.In the BA area,the tumor had a bilayered structure of luminal cells and basal cells.The basal cells were positive for CK5/6 and p40,but the MA area was negative for these biomarkers.The Ki-67 proliferation index was low(1%-2%).The patient was diagnosed with BA accompanied by MA,and had a favorable outcome.CONCLUSION The present study indicated that BA may be carcinogenic,and suggests that clinicians should be aware of its potential for malignant transformation.
文摘BACKGROUND The clinicopathological features,immunohistochemical characteristics,and genetic mutation profile of two unusual cases of distal bronchiolar adenoma are retrospectively analyzed and the relevant literature is reviewed.CASE SUMMARY Case 1 was a 63-year-old female patient who had a mixed ground-glass nodule,with mild cells in morphology,visible cilia,and bilayer structures in focal areas.Immunohistochemical staining for P63 and cytokeratin(CK)5/6 revealed the lack of a continuous bilayer structure in most areas,and no mutations were found in epidermal growth factor receptor,anaplastic lymphoma kinase,ROS1,Kirsten rat sarcoma,PIK3CA,BRAF,human epidermal growth factor receptor-2(HER2),RET,and neuroblastoma RAS genes.Case 2 was a 58-year-old female patient who presented with a solid nodule,in which most cells were observed to be medium sized,the nuclear chromatin was pale and homogeneous,local cells had atypia,and cilia were found locally.Immunohistochemical staining for P63 and CK5/6 showed no expression of these proteins in mild cell morphology whereas the heteromorphic cells showed a bilayer structure.The same nine genes as above were analyzed,and HER2 gene mutation was identified.CONCLUSION Some unresolved questions remain to be answered to determine whether the lesion is a benign adenoma or a part of the process of malignant transformation from benign adenoma of the bronchial epithelium.Furthermore,whether lesions with atypical bilayer structures are similar to atypical hyperplastic lesions of the breast remains to be elucidated.Moreover,clarity on whether these lesions can be called atypical bronchiolar adenoma and whether they are invasive precursor lesions is needed.Future studies should examine the diagnostic significance of HER2 gene mutation as a prognostic indicator.
文摘背景与目的肺纤毛黏液结节性乳头状肿瘤(ciliated muconodular papillary tumor of the lung,CMPT)的发病极其少见,在临床上与其他肺部病变亦难以区别,易造成误诊、漏诊;通过收集CMPT的资料,分析其临床病理特征,可以为广大医务工作者提供诊治思路,减少医疗差错。方法回顾性分析1例典型的CMPT患者的临床资料、病理特征、免疫表型并结合相关文献进行探讨。结果患者胸部计算机断层扫描(computed tomography,CT)提示右下肺近胸膜处可见混合密度结节影,直径约9 mm,肿瘤行肺楔形切除术,镜下见结节由增生的纤毛细胞、黏液细胞及基底样细胞混合组成,以乳头状、腺样结构为主,纤毛细胞衬覆于乳头状结构表面,基底样细胞位于外层,黏液细胞则位于两者之间,各种细胞异型不明显。免疫组化:上皮细胞CEA(+)、CK7(+)、CA125(+)、TTF-1(弱+)、CK20(-)、Ki67(1%+)、CK5/6(+);基底细胞P63(+)。结论CMPT是一种新近发现的罕见的肺部肿瘤,关于其良恶性目前尚无定论,但多数学者倾向于良性,其在影像学上可表现出诸多恶性肿瘤征象而常被误认为是肺腺癌,通过其典型的病理组织学特点及免疫组化表型可与其他肺部疾病进行鉴别,基因突变是否是其驱动因素目前尚不得知,该肿瘤行手术切除预后较好。
