细支气管腺瘤的CT表现及病理分析初步探索

潘小环; 何萍; 陈淮

doi:10.15953/j.ctta.2022.247

细支气管腺瘤的CT表现及病理分析初步探索

doi: 10.15953/j.ctta.2022.247

潘小环^{1, a,},
何萍^{1, b, ,},
陈淮²

1.
放射科；广州医科大学附属第一医院
2.
病理科，广州510120 广州医科大学附属第一医院
2.
广州医科大学附属第二医院放射科, 广州510260

基金项目: 广东省自然科学基金-面上项目（2019A1515011390）。

详细信息

作者简介:
潘小环：女，广州医科大学附属第一医院放射科医师，E-mail：cirwen727@163.com

通讯作者:
女，广州医科大学附属第一医院病理科主任医师，E-mail：hp5567@163.com

计量
- 文章访问数: 11
- HTML全文浏览量: 5
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2022-12-12
- 修回日期: 2023-04-21
- 录用日期: 2023-04-25
- 网络出版日期: 2023-09-12

CT Findings and Preliminary Exploration of Pathological Analysis of Bronchiolar Adenoma

PAN Xiaohuan^{1, a
,},
HE Ping^{1, b
, ,},
CHEN Huai²

1.
the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China Department of Radiology
2.
the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China Department of Pathology
2.
Department of Radiology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China

摘要

摘要: 目的：总结分析细支气管腺瘤的临床资料、CT征象、病理特征，探讨其对该病的诊断价值。方法：回顾性收集2020年1月至2020年12月术后经病理确诊为细支气管腺瘤的肺部结节18例，分析患者的临床资料、肺结节胸部CT征象及术后病理特征。结果：18例患者中16例无临床胸部症状，2例出现胸痛；年龄18～65岁，平均年龄51.8岁，中位年龄（25％～75％分位数）为52（49～59）岁，其中男性7例（39％），女性11例（61％）。胸部CT结节最大层面平均直径为11.1 mm，中位直径（25％～75％分位数）为8（6～15）mm，病灶距离胸膜位置≤10 mm者共15例。CT上表现为纯磨玻璃结节8例，部分实性结节7例，3例表现为单纯囊腔。表现为pGGN的细支气管腺瘤（8例）平均CT值为-690.7 HU，中位平均CT值（25％～75％分位数）为-717.5（-722～-681）HU。18例结节中边缘有毛刺征6例，结节周围出现胸膜牵拉征7例，结节内出现细支气管扩张5例。18例结节术后大体病理平均直径为9.1 mm，中位直径（25％～75％分位数）为7（6～9）mm。免疫组化抗体CK7阳性18例、p40、p63、CK5/6、TTF-1阳性均为16例。结论：胸膜下10 mm左右结节术前CT诊断时不容忽视该病，免疫组化抗体CK7、p40等指标是诊断细支气管腺瘤的定性方法。
- 肺肿瘤 /
- 细支气管腺瘤 /
- 体层摄影术 /
- 诊断
Abstract: Objective: To summarize and analyze the clinical data, CT signs, and pathological features of bronchiolar adenoma, and to discuss the diagnostic value of bronchiolar adenoma. Methods: In total, 18 cases of pulmonary nodules diagnosed as bronchiolar adenoma via postoperative pathology from January 2020 to December 2020 were retrospectively collected, and the clinical data, chest CT signs, and postoperative pathological features of pulmonary nodules were analyzed. Results: Among the 18 cases, 16 had no clinical chest symptoms, and 2 had chest pain. The patients were 18～65 years old. The mean age was 51.8 years, and the median age (25％～75％ quantile) was 52 (49～59) years; 7 patients were male (39％), and 11 were females (61％). The average maximum slice diameter of bronchiolar adenoma was 11.1 mm, and the median diameter (25％～75％ quantile) was 8 (6～15) mm. There were 15 cases with lesion distance ≤10 mm from the pleura. CT showed that 8 cases were pure ground-glass nodules (pGGN), 7 cases were part-solid nodules (PSN), and 3 cases had simple cystic space. The mean CT value of bronchiolar adenomas presenting with pGGN was −690.7 HU. The median mean CT value (25％～75％ quantiles) was −717.5 (−722～ −681) HU. A spicule sign at the nodular margin was found in 6 of the 18 cases. Pleural traction around nodules was found in 7 cases, and bronchiectasis occurred in nodules in 5 cases. The postoperative gross pathological diameter of 18 nodules was 9.1 mm, and the median diameter (25％～75％ quantile) was 7 (6～9) mm. Pathological immunohistochemical antibody CK7 was positive in 18 cases; p40, p63, CK5/6, and TTF-1 were positive in 16 cases. Conclusions: Bronchiolar adenoma often occurs in middle-aged and older women. Preoperative CT diagnosis of subpleural nodules around 10 mm could indicate the disease, and immunohistochemical antibody CK7, p40, and other indicators are qualitative methods for diagnosing bronchiolar adenoma.
- lung cancer /
- bronchiolar adenoma /
- computed tomography /
- diagnosis

HTML全文

图 1 细支气管腺瘤的CT图像

（a）女，18岁，左肺下叶前内基底段胸膜下纯磨玻璃结节，直径约8 mm，边界清，密度均匀，形态规则。（b）女，51岁，右肺下叶背段纯磨玻璃结节，直径约8 mm，边界清，密度均匀，形态规则，内见小空泡。（c）女，58岁，左肺上叶前段胸膜下纯磨玻璃结节，直径约6 mm，边界清，密度均匀，形态规则。（d）男，57岁，右肺下叶外基底段胸膜下部分实性小结节，直径约9 mm，边界清，密度不均匀，形态不规则，少许毛刺征、胸膜牵拉征、内见小囊腔。（e）女，59岁，右肺下叶外基底段胸膜下单纯囊腔影，直径约20 mm，壁厚2 mm，边界清，形态规则，胸膜牵拉征。（f）男，53岁，左肺下叶外基底段胸膜下小囊腔影，直径约7 mm，壁厚2 mm，边界清，形态规则，可见胸膜牵拉征。

Figure 1. CT image of bronchiolar adenomas

下载: 全尺寸图片幻灯片

图 2 女，58岁患者的病理图

（a）～（c）免疫组结果：TTF-1（+），CK7（+），p40/p63（基底细胞+），CK5/6（基底细胞+），Ki-67（热点区约3％+）。（a）：HE染色，低倍放大。（b）和（c）：分别为p40、CK5/6免疫组化显示基底细胞层。

Figure 2. Female, 58 years old Pathology of the patient

下载: 全尺寸图片幻灯片

表 1 细支气管腺瘤CT形态学特点

Table 1. CT morphological features of bronchiolar adenoma

HRCT征象		数值/例数	P
直径中位数/mm		8
结节位置	左上肺	4	0.032
	左下肺	6
	右上肺	2
	右中肺	0
	右下肺	6
距离胸膜位置	≤10 mm	15	＜0.01
距离胸膜位置	＞10 mm	3
结节性质	纯磨玻璃结节	8	0.271
	部分实性结节	7
	单纯囊腔结节	3
pGGN的平均CT值中位数/HU		-717.5
边缘	清晰	13	0.018
边缘	不清晰	5
密度	均匀	7	0.318
密度	不均匀	11
形态	圆形/类圆形	9	1
形态	不规则形	9
毛刺征		6	0.094
胸膜牵拉征		7	0.318
细支气管扩张		5	0.018

下载: 导出CSV

表 2 细支气管腺瘤大体病理及免疫组化特点

Table 2. Gross pathological and immunohistochemical characteristics of bronchiolar adenoma

大体病理及免疫组化	数值（阳性）/例
大体病理中位数/mm	7
CK7	18
p40	16
p63	16
CK5/6	16
TTF-1	16

下载: 导出CSV

参考文献(12)

[1]	CHANG J, MONTECALVO J, BORSU L, et al. Bronchiolar adenoma: Expansion of the concept of ciliated muconodular papillary tumors with proposal for revised terminology based on morphologic, immunophenotypic, and genomic analysis of 25 casesa[J]. American Journal of Surgical Pathology, 2018, 42: 1010−1026. doi: 10.1097/PAS.0000000000001086
[2]	WANG H, LIN D L, HU Y J, et al. Solitary peribronchiolar metaplasia and bronchiolar adenoma: Do they represent an equal entity?[J]. General Thoracic and Cardiovascular Surgery, 2020, 68(2): 204−205. doi: 10.1007/s11748-019-01224-1
[3]	张杰, 邵晋晨, 韩昱晨, 等. 细支气管腺瘤病理诊断若干问题[J]. 中华病理学杂志, 2020,(06): 529−533. DOI: 10.3760/cma.j.cn112151-20190821-00459. ZHANG J, SHAO J C, HAN Y C, et al. Issues on pathological diagnosis of bronchiolar adenoma[J]. Chinese Journal of Pathology, 2020, (06): 529−533. DOI: 10.3760/cma.j.cn112151-20190821-00459. (in Chinese).
[4]	SHIRSAT H, ZHOU F, CHANG J, et al. Bronchiolar adenoma/pulmonary ciliated muconodular papillary tumor[J]. American Journal of Clinical Pathology, 2021, 155(6): 832−844. doi: 10.1093/ajcp/aqaa194
[5]	GUO Y, SHI Y, TONG J. Bronchiolar adenoma: A challenging diagnosis based on frozen sections[J]. Pathology International, 2020, 70(3): 186−188. doi: 10.1111/pin.12901
[6]	JOHN H, NESTOR L, PAUL J, et al. glossary of terms for CT of the lungs: recommendations of the nomenclature committee of the fleischner society[J]. Thoracic Radiology, 1996, 200: 327−331.
[7]	WU F, TIAN S P, JIN X, et al. CT and histopathologic characteristics of lung adenocarcinoma with pure ground-glass nodules 10 mm or less in diameter[J]. European Radiology, 2017, 27(10): 4037−4043. doi: 10.1007/s00330-017-4829-5
[8]	CAO L, WANG Z, GONG T, et al. Discriminating between bronchiolar adenoma, adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung with CT[J]. Diagnostic and Interventional Imaging, 2020, 101(12): 831−837. doi: 10.1016/j.diii.2020.05.005
[9]	高何, 杜晓刘, 陈春妮, 等. 细支气管腺瘤15例临床病理学观察[J]. 中华病理学杂志, 2020,(6): 556−561. DOI: 10.3760/cma.j.cn112151-20191125-00755. GAO H, DU X L, CHEN C N, et al. Bronchiolar adenoma: A clinicopathological analysis of 15 cases[J]. Chinese Journal of Pathology, 2020, (6): 556−561. DOI: 10.3760/cma.j.cn112151-20191125-00755. (in Chinese).
[10]	牛传岭, 苗森, 陈雪, 等. 细支气管腺瘤一例[J]. 中华病理学杂志, 2020,(09): 946−948. DOI: 10.3760/cma.j.cn112151-20191226-00830. NIU C L, MIAO S, CHEN X, et al. Bronchiolar adenoma: Report of a case[J]. Chinese Journal of Pathology, 2020, (09): 946−948. DOI: 10.3760/cma.j.cn112151-20191226-00830. (in Chinese).
[11]	PAN X H, YANG X G, LI J X, et al. Is a 5-mm diameter an appropriate cut-off value for the diagnosis of atypical adenomatous hyperplasia and adenocarcinoma in situ on chest computed tomography and pathological examination?[J]. Journal of Thoracic Disease, 2018, 10(7): 790−796.
[12]	潘小环, 李靖煦, 刘远明, 等. 表现为纯磨玻璃结节的微浸润腺癌与浸润性腺癌的薄层CT鉴别诊断[J], 实用放射学杂志, 2020, 36(7): 1043-1047. doi: 10.3969/j.issn.1002-1671.2020.07.008. PAN X H, LI J X, LIU Y M, et al. Differential diagnosis of minimally invasive adenocarcinoma and invasive adenocarcinoma presenting as pure ground glass nodules using thin-slice CT[J]. Journal of Practical Radiology, 2020, 36(7): 1043-1047. doi:10.3969/j.issn.1002-1671.2020.07.008. (in Chinese).