Background and objective: Treatment of pulmonary carcinoid is a comprehensive modality focusing on surgery. Thus, accurate and timely preoperative and intraoperative pathological diagnoses are very crucial. The aim of this study is to retrospectively analyze the pathological characteristics of pulmonary carcinoid, its natural history, and patterns of disease progression to obtain evidence for clinical decision making.
Methods: Clinical and pathological data of 32 patients with pulmonary carcinoid were retrieved and retrospectively analyzed. The pathological characteristics and their relationship with clinical diagnosis and treatment effect were systematically studied.
Results: Among the 32 patients, 18 had typical carcinoid and 14 had atypical carcinoid. The male-to-female ratio was 2.2:1, and the average age was (44±15) years. Almost half of the patients were discovered by accident. The average maximum diameter was (3.1±1.3) cm. About 27 of all 32 cases (84.4%) were stage I, 2 were stage IIa, 2 were stage IIIa, and 1 was stage IV. The follow-up time was 5.2-9.7 years. The 5-year progression free survival of 15 typical carcinoid patients and 12 atypical carcinoid patients were 100% and 92.9%, respectively. The characteristic neuroendocrine morphology and variable expression levels of cytokeratin, chromogranin A, synaptophysin, CD56, and index of Ki-67 were important factors that differentiated pulmonary carcinoid from other tumors.
Conclusions: Pathological diagnosis of pulmonary carcinoid must combine morphology with immunohistochemistry. Early-stage patients can also achieve good effect after surgery.
背景与目的 肺类癌采取以手术为主的多学科治疗，准确及时的病理诊断至关重要。本研究探讨肺类癌的病理特质，结合回顾性分析患者的转归预后，为临床决策提供依据。方法 收集支气管肺内发生的类癌手术标本32例，回顾性分析患者相关的临床病理资料，系统研究病灶病理学表现与临床诊断和治疗效果的相关性。结果 32例肺类癌患者中，典型类癌18例，不典型类癌14例；男女性别比为2.2:1；平均年龄（44±15）岁；近半数患者无症状；肿瘤最大径（3.1±1.3） cm；绝大多数为I期患者（84.4%, 27/32），余IIa期2例，IIIa期2例，IV期1例；随访时间为5.2年-9.7年；其中典型类癌随访15例，5年无进展生存率为100%；不典型类癌随访12例，5年无进展生存率为92.9%；肺类癌病理组织学的特质是典型的神经内分泌形态伴细胞角蛋白阳性，嗜铬素A、突触素和CD56等神经内分泌指标的表达，Ki-67指数的高低有助于鉴别诊断。结论 肺类癌的病理鉴别诊断应结合相关酶标染色，积极争取手术是适宜的临床决策。