A distinctive cytomorphological feature of interstitial pneumonia?related lung adenocarcinoma: The potential issues and solutions in practical diagnosis
A distinctive cytomorphological feature of interstitial pneumonia?related lung adenocarcinoma: The potential issues and solutions in practical diagnosis
复制标题
间质性肺炎相关肺腺癌独特的细胞形态学特征：实际诊断中的潜在问题和解决方案
DOI：
10.1002/cncy.22666
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发表时间：
2022
影响因子：
3.4
通讯作者：
Okudela Koji
中科院分区：
文献类型：
--
作者：
Sugiyama Misaki;Matsumura Mai;Sekiya Motoki;Honda Emi;Sekine Akimasa;Arai Hiromasa;Okudela Koji
背景：间质性肺炎（IP）相关肺腺癌（LADC）的细胞学特征尚未明确描述。本研究旨在描述其细胞形态学特征，揭示实际细胞学诊断中可能存在的问题，并提供可能的解决方案。方法对40例与IP相关的LADC （IP组）和110例与IP无关的LADC（非IP组）的支气管刷痰细胞学样本进行分析。所有患者均在刷毛细胞学检查后行手术，并确定其组织病理学亚型。作者回顾了细胞学特征，并特别关注细胞质粘蛋白的产生。结果IP组细胞质黏液蛋白阳性的肿瘤细胞检出率（44.4% [18 / 8]vs. 6.3%[64 / 4]）显著高于对照组，且以浸润性黏液腺癌（IMAs）居多。IP组的40例LADC病例中有22例未能被判断为“恶性/阳性”（因此，它们被判断为“模棱两可和/或阴性”）。在IP组中，模棱两可和/或消极判断的频率为55.0%（40人中有22人），而在非IP组中为41.8%（110人中有46人）。IMA的细胞学诊断是困难的，因为它只显示轻微的核异型。因此，作者检测了IMA诊断标志物肝细胞核因子4α (HNF4α)的免疫细胞化学表达。结果，在IP组中被判断为模棱两可的6例中，有4例显示出阳性信号，可以回顾性判断为恶性/阳性。结论由于IMA的比例较大，IP相关性LADC的细胞学诊断可能更加困难。免疫细胞化学检测HNF4α可提高IP相关LADC的诊断可信度。
BackgroundThe cytological features of interstitial pneumonia (IP)–related lung adenocarcinoma (LADC) have not been clearly described. This study aimed to describe its cytomorphological features, uncover potential problems in practical cytological diagnosis, and provide possible solutions.MethodsBronchial brushing cytology samples from 40 IP‐related LADC cases (the IP group) and 110 control cases (LADC unrelated to IP; the non‐IP group) were analyzed. All patients underwent surgery after brushing cytology, and their histopathological subtypes were determined. The authors reviewed the cytological features and focused particularly on cytoplasmic mucin production.ResultsIn the IP group, neoplastic cells with cytoplasmic mucin were detected at a significantly higher frequency (44.4% [8 of 18] vs. 6.3% [4 of 64]), and most of them were invasive mucinous adenocarcinomas (IMAs). Twenty‐two of the 40 LADC cases in the IP group failed to be judged as “malignant/positive” (thus, they were judged to be “equivocal and/or negative”). The frequency of equivocal and/or negative judgments was 55.0% (22 of 40) in the IP group and 41.8% (46 of 110) in the non‐IP group. The cytological diagnosis of IMA was difficult because it showed only slight nuclear atypia. Therefore, the authors examined the immunocytochemical expression of hepatocyte nuclear factor 4α (HNF4α), a diagnostic marker for IMA. As a result, four of the six cases that were judged to be equivocal in the IP group showed positive signals and could be retrospectively judged as malignant/positive.ConclusionsThe cytological diagnosis of IP‐related LADC may be more difficult because of the larger proportion of IMA. Immunocytochemistry for HNF4α can be used to improve diagnostic confidence in IP‐related LADC.