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中华肺部疾病杂志(电子版) ›› 2023, Vol. 16 ›› Issue (05) : 752 -754. doi: 10.3877/cma.j.issn.1674-6902.2023.05.041

病例报告

多灶微结节性肺泡上皮增生一例
冼诗萍, 李展宇(), 何建忠, 唐蕾, 赖俊, 刘野   
  1. 519000 珠海,中山大学附属第五医院病理科
  • 收稿日期:2023-04-07 出版日期:2023-10-25
  • 通信作者: 李展宇

One case of multifocal micronodular alveolar epithelial hyperplasia

Shiping Xian, Zhanyu Li(), Jianzhong He   

  • Received:2023-04-07 Published:2023-10-25
  • Corresponding author: Zhanyu Li
引用本文:

冼诗萍, 李展宇, 何建忠, 唐蕾, 赖俊, 刘野. 多灶微结节性肺泡上皮增生一例[J]. 中华肺部疾病杂志(电子版), 2023, 16(05): 752-754.

Shiping Xian, Zhanyu Li, Jianzhong He. One case of multifocal micronodular alveolar epithelial hyperplasia[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(05): 752-754.

多灶微结节性肺泡上皮增生(multifocal micronodular pneumocyte hyperplasia, MMPH)是结节性硬化症(tuberous sclerosis complex, TSC)的肺部病变之一,临床症状不明显,常于偶然或体检发现,影像学示多个小磨玻璃样结节影,病理表现为多个Ⅱ型肺泡上皮细胞沿肺泡壁增生灶。MMPH较为罕见,容易误诊为各种感染病或肺恶性肿瘤,需结合临床、影像及病理结果明确诊断。本文对我院收治的MMPH患者1例进行分析,报告如下。

图1 MMPH的影像学表现。注:A:示手术前双肺弥漫结节影,大部分为纯磨玻璃或混杂磨玻璃结节,少部分呈实性结节,最大直径约7 mm;B:胸椎可见广泛密度减低并斑点状硬化;C:部分肋骨内可见广泛密度减低并斑点状硬化;D:示手术后左肺上叶部分缺如,余双肺弥漫结节,大部分为纯磨玻璃或混杂磨玻璃,最大7.8 mm,少部分呈实性,随机分布
图2 MMPH的病理病理学表现。注:A:部分病灶内肺泡腔扩张,Ⅱ型肺泡上皮沿肺泡壁增生,间质散在淋巴细胞等炎细胞浸润(HE×40);B:增生的肺泡上皮细胞呈鞋钉样,细胞及细胞核均增大,部分可见小核仁,胞浆丰富,核浆比未见明显增高(HE×100);C:部分肺泡塌陷,腔内组织细胞聚集,肺泡间隔增宽,纤维组织增生(HE×100);D:细胞呈扁平、立方和多边形,异型性不明显,肺泡腔内组织细胞聚集(HE×200);E:免疫组织化学TTF-1染色示增生的肺泡上皮阳性(EnVision法×100);F:p40示基底细胞缺失(EnVision法×100);G: CD68示肺泡腔内组织细胞阳性(EnVision法×100);H:肺泡间隔内弹力纤维增生,排列紊乱(弹力纤维染色×100)
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