硬化性肺细胞瘤诊断陷阱邮件.pdfVIP

Diagnostic pitfalls and the relationship between two major cell types in sclerosing-pneumocytoma En-Hua Wang China Medical University Four histological patterns and two cell types CK, SP-B, Vimentin and TTF-1 assist diagnosis CK SP-B Vimentin TTF-1 Hum Pathol. 2004, 35(4):503 Cells isolated by laser capture micro-dissection Different expression spectrum of mRNAs in two cell types ? Many PSH cases were misdiagnosed as malignant tumors ? Only 20% of patients were correctly diagnosed in preoperative biopsy ? Intraoperative frozen-section assessments for PSH has an error ratio of 25% ? About 50% of patients received unnecessary extensive surgery procedures Misdiagnosis of PSH leads to over therapy Low SY, et al. Asian Cardiovasc Thorac Ann. 2011, 19(2):139 I、Pitfalls in diagnosis 1. Multiple nodules in unilateral or bilateral lungs 2. Histological variant —— sclerotic papillae 3. Cell variant —— multinuclear giant cells TTF-1 SP-B Multinuclear giant cells mixed with sclerotic papillary 4. Diffused spindle cells resemble tumors of soft tissues TTF-1 5. Features of small PSH In 280 cases of PSH collected，46 cases ＜ 1cm， 12 cases ＜ 0.5cm. Solid pattern in most small PSH 3.8mm Focal sclerosis, lacking papillary and hemorrhagic patterns 2.9mm CK, Vimentin and TTF-1 are simultaneously expressed in stromal polygonal cells in small PSH CK Vimentin 6.对基本结构认识不足 ?病例1：女，47岁，近肺门3×3×2.5cm，灰褐色、界清 ? HE1, HE2 ?原单位诊断：倾向于血管源性肿瘤；硬化性血管瘤 组化：CD34血管+，calretinnin灶+，WT1胞浆+ ，CK19-， Syn灶状+， LCA-， CD10灶状+， Ki67＞5% CD68组织细胞+，TTF1-，HMB45- 复旦肿瘤医院会诊：考虑为间叶源性肿瘤，建议参照具有 恶性潜能的肿瘤处理，注意术后随访 上海胸科医院会诊：考虑间叶源性，不除外转移， 请结合临床 补充组化：HMB45（+），SMA（-） 诊断：PEComa（混合型） 7.免疫组化的干扰—Vimentin、CD117 MCT 病例2：女，50岁，右肺上叶占位，1.6cm， 临床诊断为恶性可能性大 ? HE