Analysis of cell type and radiographic presentation as predictors of the clinical course of patients with bronchioloalveolar cell carcinoma
Analysis of cell type and radiographic presentation as predictors of the clinical course of patients with bronchioloalveolar cell carcinoma
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DOI：
10.1378/chest.113.4.997
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发表时间：
1998-04-01
期刊：
影响因子：
9.6
通讯作者：
Farber, JL
中科院分区：
文献类型：
--
作者：
Albertine, KH;Steiner, RM;Farber, JL
研究目的：细支气管肺泡癌是一种组织病理学、放射学和临床表现多变的原发性肺肿瘤。细支气管肺泡癌有三种细胞类型：Clara细胞、黏液生成细胞和肺泡II型上皮细胞。目前尚不清楚这三种肿瘤细胞类型是否与特定的放射学表现和临床病程相关。在这项研究中，我们研究了通过透射电子显微镜鉴定的肿瘤细胞类型是否与特定的放射学模式相关，以及肿瘤细胞类型或放射学表现是否与患者的临床过程和结果相关。设计：采用透射电镜对10年间（1980 - 1990年）诊断为原发性细支气管肺泡癌的54例患者的原始手术组织病理标本中的组织块进行重新研究。我们回顾了每个病例的前处理x线片，并将每个患者发现肿瘤时获得的第一张胸片与超微结构研究结果进行了比较。检查每位患者的医疗记录，以获得相关的放射学、临床和患者预后信息。测量与结果：Clara细胞瘤32例，产生黏液细胞瘤10例，肺泡II型上皮细胞瘤1例。另外11个肿瘤含有两种或两种以上细胞类型的混合物。肿瘤细胞类型与放射学表现或患者死亡模式之间没有统计学意义的关系。影像学上表现为节段性、大叶性、多灶性或弥漫性疾病的患者死亡率高于表现为孤立性肺结节的患者。结论：影像学表现，而不是肿瘤细胞类型，提供了有助于预测患者预后的预后信息。
Study objectives: Bronchioloalveolar carcinoma is a primary lung neoplasm of variable histopathologic, radiologic, and clinical expression. There are three cell types described in bronchioloalveolar carcinoma: Clara cells, mucin-producing cells, and alveolar type II epithelial cells. It is unclear whether these three tumor cell types are associated with a specific radiologic presentation and clinical course. In this study, we investigated whether tumor cell type, identified by transmission electron microscopy, correlated with a specific radiologic pattern, and whether tumor cell type or radiologic presentation correlated with the patient's clinical course and outcome.Design: Transmission electron microscopy was used to restudy tissue blocks from the original surgical histopathologic specimens in 54 patients with primary bronchioloalveolar carcinoma diagnosed over a 10-year period (1980 to 1990). The pretreatment radiographs were reviewed in each case, and the first chest radiograph obtained at the time of the discovery of the tumor in each patient was compared with the results of the ultrastructural study. The medical records of each patient were examined to obtain pertinent radiologic, clinical, and patient outcome information.Measurement and results: There were 32 Clara cell tumors, 10 mucin-producing cell tumors, and 1 alveolar type II epithelial cell tumor in this series. Eleven additional tumors had mixtures of two or more cell types. No statistically significant relationship was detected between tumor cell type and radiologic presentation or patient mortality pattern. There was increased mortality among patients who presented radiologically with segmental, lobar, multifocal, or diffuse disease compared with those patients exhibiting a solitary pulmonary nodule at presentation.Conclusion: Radiologic presentation, rather than tumor cell type, provides prognostic information that aids in predicting patient outcome.