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目的探讨支气管扩张症伴发肺神经内分泌细胞增生及微小瘤形成的临床病理学意义,旨在提高对肺支气管扩张症伴发肺神经内分泌细胞增生及微小瘤形成的诊断能力。方法随机选取2009年10月—2012年10月收治的15例肺支气管扩张症伴发肺神经内分泌细胞增生及微小瘤形成患者,采用组织学、免疫组织化学及组织化学技术对其开展光镜检测及免疫标记,对其临床症状、影像学特征、组织形态和免疫组织化学特征等进行回顾性分析。结果 15例患者中,男6例,女9例,男女比例2∶3;年龄范围31~69岁,平均(49.3±5.1)岁。术后对10例患者进行跟踪回访,回访时间15个月~5年,平均时间(26.2±11.2)个月,无类癌并发,1例合并肺癌患者手术死亡。1例采取部分肺叶切除治疗标本,呈现出灰白色小结节,直径不足5mm,界限清晰,切面呈灰白色,囊实性,质地偏软。镜下检测结果显示,15例标本有明显支气管扩张症病理特点,包括肺内多灶性支气管扩张,大量中性粒细胞、淋巴细胞包绕,15例标本周围均有神经内分泌样细胞结节(一处7例,多处8例),结节直径范围1.0~4.5mm,平均直径(1.3±0.5)mm。CD56、突触素(Syn)、嗜铬素(CgA)、甲状腺核转录因子1(TTF-1)均为阳性,7例Ki-67阳性指数均<1%。结论联合术前、术中病理学检测可有效提升对肺支气管扩张症伴发肺神经内分泌细胞增生及微小瘤形成的诊断能力,免疫组织化学K-i67、CD56、突触素(Syn)、嗜铬素(CgA)、甲状腺核转录因子1(TTF-1)作用于该病具有临床重要意义。
Objective To investigate the clinicopathological significance of bronchiectasis associated with pulmonary neuroendocrine cell hyperplasia and microminoma formation and to improve the diagnostic ability of pulmonary bronchiectasis with pulmonary neuroendocrine cell hyperplasia and microminoma formation. Methods Totally 15 patients with pulmonary bronchiectasis with pulmonary neuroendocrine cell hyperplasia and micro-neoplasia were selected from October 2009 to October 2012. The patients were followed up with light microscopy using histological, immunohistochemical and histochemical techniques And immune markers, the clinical symptoms, imaging features, histological features and immunohistochemical features were retrospectively analyzed. Results Among the 15 patients, 6 were male and 9 were female, the ratio of male to female was 2: 3. The age ranged from 31 to 69 years, with an average of (49.3 ± 5.1) years. Ten patients were followed up for 15 months to 5 years with a mean duration of (26.2 ± 11.2) months. There were no cancer-like complications and 1 patient died of lung cancer. One case was treated with partial lobectomy, showing small white nodules with a diameter of less than 5 mm, clear boundaries, gray-white section, cystic solidity and soft texture. Microscopic examination showed that 15 cases of pathological features of bronchiectasis were obvious, including multifocal lung bronchiectasis, a large number of neutrophils, lymphocytes surrounded by 15 cases of specimens around neuroendocrine cell nodules ( One in 7 cases and multiple in 8 cases). The diameter of nodules ranged from 1.0 to 4.5 mm with an average diameter of 1.3 ± 0.5 mm. CD56, Syn, CgA and TTF-1 were all positive, and the positive index of Ki-67 in all 7 cases was less than 1%. Conclusions Combined preoperative and intraoperative pathological examination can effectively improve the diagnosis of pulmonary neuroendocrine cell proliferation and micro-neoplasia with pulmonary bronchiectasis. The immunohistochemistry K-i67, CD56, syn, Chromium (CgA) and thyroid nuclear factor 1 (TTF-1) have clinical significance in this disease.