CT Findings and Preliminary Exploration of Pathological Analysis of Bronchiolar Adenoma
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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。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.
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Key words:
- lung cancer /
- bronchiolar adenoma /
- computed tomography /
- diagnosis
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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
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 >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 不清晰 5 密度 均匀 7 0.318 不均匀 11 形态 圆形/类圆形 9 1 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 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 -
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