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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。
Objective To analyze the clinicopathological and immunohistochemical features of atypical adenomatous hyperplasia (AAH) in lung. Methods The clinical data of 8 cases of AAH were collected. The expression of p53, EGFR, c-erbB-2, thyroid transcription factor (TFF-1), p16 and Ki- 67 expression] analysis of its clinical and pathological features and immunophenotype characteristics. Results The average age of 8 cases of AAH was 52 years. The ratio of male to female was 1: 3. Two cases were long-term smoking. The clinical manifestations were nonspecific. Three cases had previous history of other parts of tumor and 4 cases had lung adenocarcinoma. CT examination showed single or Multiple small pieces of high-density film; microscopic examination showed tumor diameter 1 ~ 6 mm, 2 cases of single lesions, 6 cases of multiple lesions, were high-grade lesions, of which 3 cases showed low-grade lesion area; 4 cases After chemotherapy, 7 cases were followed up for a mean of 23 months without recurrence or enlarged lesions. Among them, 5 were positive for p16 in immunohistochemical AAH and 5 were for TTF-1, except for 1 in 5 of them, Ki-67 proliferation index 1 was positive for p53, 1 was positive for EGFR and negative for c-erbB-2. The positive rates of p16 in 4 cases of adenocarcinoma with AAH and adenocarcinoma were 4 cases TTF-1 positive, 4 cases of Ki-67 proliferation index were 2%, 2%, 5% and 40%, 1 case of p53 positive, 3 cases of EGFR positive c-erbB-2 were negative. Conclusions AAH and adenocarcinoma of the lung often accompany with each other. It is important to diagnose patients with AAH closely followed by high-resolution CT. Combined diagnosis of multiple AAH through clinical and imaging modalities is of great significance in the diagnosis.