Pulmonary mixed squamous cell and glandular papilloma clinicopathological characteristics of 2 cases and misdiagnosis analysis of frozen section

Abstract

Abstract:

Objective:To discuss the clinicopathologic characteristics of pulmonary mixed squamous cell and glandular papilloma(PMSGP), and to analyze the key points for diagnosis and the causes of misdiagnosis of frozen section.Methods:Two cases of PMSGP diagnosed by pathology at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from 2019 to 2021 were enrolled, and the clinicopathologic and immunohistochemical characteristics and key points of frozen section diagnosis were analyzed based on literature review.Results:Two patients, a 74-year-old female and a 66-year-old male, were found to have pulmonary nodules in physical examination. One patient had chest tightness and pain. All nodules were considered as malignant tumors on imaging and lobectomy was performed. Frozen sections indicated one case was diagnosed as mucinous adenocarcinoma and the other diagnosed as PMSGP, but mucoepidermoid carcinoma could not be ruled out. In the paraffin section, the tumor sizes of 2 cases were 3.0 cm×2.5 cm×2.5 cm and 1.7 cm×1.7 cm×1.6 cm respectively. PMSGP displayed a papillary growth pattern lined by glandular epithelial cells and squamous cells. Inflammatory cells were observed along the papillary axis. Squamous epithelium could be mild to moderately atypical with rare mitosis and no necrosis. Immunohistochemistry examination showed that CK7 and TTF-1 were expressed in glandular epithelial cells, MUC5AC was expressed in mucinous columnar epithelial cells, squamous cells and basal-like cells expressed CK5/6, P63, P40 and Ki-67 was highly expressed only in the basal layer.MAML2rearrangement was not detected in the 2 cases by FISH. No recurrence or metastasis was observed at 9 and 24 months of follow-up. A literature review of 39 cases showed that due to the morphological crossover with mucoepidermoid carcinoma and mucinous adenocarcinoma, and the atypical nature of the covered squamous epithelium was easily amplified in frozen section diagnosis, the misdiagnosis rate of PMSGP of tumor properties on frozen section is as high as 52.6%.Conclusions:PMSGP is a rare benign tumor of the lung, that has a high rate of misdiagnosis on frozen section. On frozen section, the tumor is well defined and has a papillary structure. The papilla is covered with squamous epithelium and glandular epithelium. Basal cells are arranged in a palisade pattern along the fibrovascular axis, and the cells are stratified without atypia. Mastering these characteristics helps to improve the diagnostic accuracy of frozen section.

Key words:Tnmor of the lung,Mixed squamous cell and glandular papilloma,Pathological examination of frozen section,Misdiagnosis

CLC Number:

R541.7

CHE Wen, LIU Jiangshu, CHEN Xiaoyan, WANG Chaofu, YUAN Fei, WANG Xuan. Pulmonary mixed squamous cell and glandular papilloma clinicopathological characteristics of 2 cases and misdiagnosis analysis of frozen section[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(04): 476-481.

Figures/Tables4

文献	病例数（男∶女）	年龄（中位年龄,岁）	肿瘤位置		最大径（cm）	分型		临床症状	随访
文献	病例数（男∶女）	年龄（中位年龄,岁）	左肺	右肺	最大径（cm）	中央	外周	临床症状	随访
Li等^{[ 5 ]}	6（4∶2）	39~67（53）	1	5	1.8~4.2	1	5	腹胀、食欲不振1例;咳嗽咳痰1例;体检发现4例	随访12~52个月（平均31个月）,其中1例术后11月胸部CT示双肺结节,考虑转移,其余均无复发转移
Lin等^{[ 6 ]}	5（2∶4）	55~70（60）	3	2	1.0~5.0	0	5	1例胸痛,1例胸痛及咳嗽,1例咳嗽及血痰,2例无症状	随访10~89个月（平均51.6个月）,均无复发转移
汪小霞等^{[ 7 ]}	5（0∶5）	42~59（48）	不详	不详	1.5~3.5	3	2	胸痛、胸闷、咳嗽咳白痰、痰中带血、发热	随访2~28个月,无复发转移
Iijima等^{[ 8 ]}	20（10∶10）	34~84（63.5）	10	10	0.9~3.0	8	12	不详	不详

文献	误诊率	冷冻病理诊断结果
Lin等^{[ 6 ]}	1/2	1例黏液表皮样癌,1例PMSGP
Iijima等^{[ 8 ]}	6/12	2例腺癌,2例腺鳞癌,1例黏液表皮样癌,1例鳞状细胞癌,5例乳头状瘤,1例无恶性证据
Yun等^{[ 9 ]}	1/1	腺癌
Miyoshi等^{[ 10 ]}	1/1	黏液表皮样癌不能除外
Feng等^{[ 11 ]}	0/1	倾向良性病变
本文	1/2	1例黏液腺癌,1例考虑PMSGP,但不除外黏液表皮样癌

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