【摘要】 目的分析肺不典型腺瘤样增生(AAH)的临床病理特征及免疫组织化学特点。方法收集8例 AAH 临床资料,通过光镜观察及免疫组织化学[EnVision 法检测 p53、内皮生长因子受体(EGFR)、c-erbB-2、甲状腺转录因子(TFF-1)、p16、Ki-67表达]分析其临床病理特征及免疫表型特点。结果 8例 AAH 平均年龄52岁,男女比例1:3,2例长期吸烟,临床表现无特异性,3例既往有其他部位肿瘤病史,4例并发肺腺癌;CT 检查可见肺内单发或多发小片状高密度影;镜下观察可见肿物直径1～6 mm,2例为单发病灶,6例为多发病灶,均为高级别病变,其中3例可见低级别病灶区域;4例经过化疗,术后随访7例,平均随访23个月无复发或病灶增多扩大等;免疫组织化学 AAH 中5例 p16阳性,5例 TTF-1阳性,5例中除1例 Ki-67增殖指数为10%外其余4例均为1%,1例 p53阳性,1例EGFR 阳性,c-erbB-2均阴性;4例 AAH 合并肺腺癌中的腺癌组织中2例 p16阳性,4例 TTF-1阳性,4例 Ki-67增殖指数分别为2%、2%、5%和40%,1例 p53阳性,3例 EGFR 阳性,c-erbB-2均阴性。结论AAH 与肺腺癌时有相伴发生,对诊断 AAH 患者应结合高分辨 CT 密切随诊,多发性 AAH 通过临床、影像(CT)结合形态学改变的综合判断对诊断有重要意义。更多还原

【Abstract】 Objective To study the clinicopathologic and immunohistoehemical features of atypical adenomatous hyperplasia(AAH)of lung.Methods Eight cases of AAH of lung were studied by light microscopy and immunohistochemieal staining for p16,thyroid transcription factor-1(TTF-1),Ki457,p53, epidermal growth factor receptor(EGFR)and e-erbB-2.Results The mean age of the patients was 52 years.The male-to-female ratio was 1:3.Two patients were chronic smokers.The clinical symptoms were relatively non-specific.Three patients had past history of non-pulmonary tumors,while 4 patients had lung adenocarcinoma.CT scan revealed solitary or muhifocal hyperdense opacities.Histologically,the lesions ranged from 1 mm to 6 mm in size.Two cases were solitary and 6 cases were muhifocal.All were of high- grade lesions.Associated low-grade component was noted in 3 cases.There was no evidence of local recurrence or disease progression in the 7 patients with post-operative follow-up information available(mean duration of follow up = 23 months).Four patients had received chemotherapy as well.Immunohistochemical study showed variable positivity for p l 6(5/8),TIF-1(5/8),Ki-67(with proliferation index ranging from 1% to 10%),p53(1/8)and EGFR(1/8).The staining for c-erbB-2 was negative(0/8).Four cases of AAH were associated with pulmonary adenoeareinoma.The adenocarcinoma cells were diffusely positive for TTF-1(4/4),variably positive for p16(2/4),Ki-67(with proliferation index ranging from 2% to 40%), p53(1/4)and EGFR(3/4),and negative for c-erbB-2(0/4).Conclusions AAH of lung is associated with pulmonary adenocareinoma.Diagnosis of AAH requires correlation with CT findings and pathologic examination.更多还原