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panyl10055 离线
男性,21y,肺大泡切除3*2*1cm。镜下见结节0.2*0.2cm。
病变直径较小0.2cm,影像学上是否有多发性病变?
除了考虑肿瘤之外,还有一个重要的鉴别诊断:即与结节性硬化相关的多灶性微结节状肺泡上皮增生(Multifocal micronodular pneumocyte hyperplasia,MMPH)。MMPH在影像学上表现为多灶性的微小结节,直径0.2-0.4cm不等,明显好发于女性,但是男性也有报道,病变与结节性硬化有关,时常伴有肺的淋巴管平滑肌瘤病;组织学表现为肺泡间隔明显增厚伴不等量的淋巴细胞以及嗜酸性粒细胞浸润,本例存在这一表现;此外肺泡上皮呈乳头状增生,可见核多形性和核内包涵体,以及明显的核仁;但核分裂不常见,肺泡腔内可见多量组织细胞增生,此为另一特征之一;免疫表型方面,肺泡上皮表达EMA,TTF1,CK,SP-A,PCNA;但不常见表达CEA,P53阴性;本例P53强阳性,这一表现似乎支持肿瘤的诊断,但是CEA阴性,KI-67增殖指数也不高。
楼主可以参考下面几篇文献,其组织学结构与本例十分类似:
Yoshihiro KOBASHI,Tadaaki SUGIU,et al.Clinicopathological analysis of multifocal micronodular
pneumocyte hyperplasia associated with tuberous sclerosis in Japan.Respirology (2008) 13, 1076–1081
Hiroshi Maruyama,Chiho Ohbayashi,et al.Pathogenesis of multifocal micronodular pneumocyte
hyperplasia and lymphangioleiomyomatosis in tuberous sclerosis and association with tuberous sclerosis genes TSC1 and TSC2.Pathology International 2001; 51: 585–594
Hiroshi Maruyama,Kuniaki Seyama,et al Multifocal Micronodular Pneumocyte Hyperplasia and
Lymphangioleiomyomatosis in Tuberous Sclerosis with a TSC2 Gene.Mod Pathol 2001;14(6):609–614
Akira Yamanaka,Masanori Kitaichi,et al.Multifocal micronodular pneumocyte hyperplasia in a postmenopausal woman with tuberous sclerosis.Virchows Arch (2000) 436:389–392.