间质性肺炎误诊为肺癌3例并文献复习

发布时间：2018-06-19 09:28

本文选题：肺肿瘤 + 间质性肺炎　；参考：《临床与实验病理学杂志》2017年05期

【摘要】：目的探讨间质性肺炎的临床病理特征。方法回顾性分析3例间质性肺炎误诊为肺癌的影像学表现和临床病理特征,并进行随访和相关文献复习。结果男性2例,女性1例,年龄分别为51、68和59岁,其中例1有长期吸烟史,3例影像学均为典型的间质性肺炎表现,高分辨率CT示3例均为肺内散在网格状、蜂窝状高密度影,以下叶为主。镜下均可见间质纤维组织增生,不同程度的炎症细胞浸润及肺泡上皮不典型增生。免疫表型:增生的肺泡上皮TTF-1、CK7、Napsin A均阳性,p63阴性,Ki-67增殖指数为2%~10%。3例首次病理诊断均被误诊为肺低分化腺癌,例1、3临床分别行2次活检,经临床反馈或多学科协作组讨论后,病理诊断均在第2次活检后得到更正。结论间质性肺炎伴不同程度肺泡上皮异型增生时与肺腺癌在病理学形态上可有重叠,鉴别诊断较为困难,易误诊,诊断时需密切结合其影像学表现,多学科协作讨论有助于加强对该疾病的认识。
[Abstract]:Objective to investigate the clinicopathological features of interstitial pneumonia. Methods the imaging features and clinicopathological features of 3 cases of interstitial pneumonia misdiagnosed as lung cancer were analyzed retrospectively. Results there were 2 males and 1 female, aged 51-68 and 59 years, respectively. Among them, case 1 had a long history of smoking and 3 cases had typical interstitial pneumonia. High-resolution CT showed that 3 cases were reticular and honeycombed. The following leaves are dominant. The interstitial fibrous tissue proliferation, inflammatory cell infiltration and atypical hyperplasia of alveolar epithelium were observed under microscope. Immunophenotype: the proliferative index of proliferating alveolar epithelium TTF-1 CK7nA was p63 negative and Ki-67 proliferation index was 2%. The first pathological diagnosis of 10.3 cases was misdiagnosed as poorly differentiated adenocarcinoma of the lung. Case 1 / 3 received two biopsies respectively. After clinical feedback or multi-disciplinary group discussion, The pathological diagnosis was corrected after the second biopsy. Conclusion there is a histopathologic overlap between pulmonary adenocarcinoma and interstitial pneumonia with different degrees of alveolar epithelial dysplasia. It is difficult to differentiate and misdiagnose. Multidisciplinary collaborative discussions help to raise awareness of the disease.
【作者单位】：复旦大学附属中山医院病理科;
【基金】：上海市卫生和计划生育委员会薄弱科室项目(2015ZB0201)
【分类号】：R563.1

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