Imaging characteristics and postoperative pathological analysis of bronchiolar adenoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SU Lei ¹ , ZHANG Yi ¹ , GAO Yan ² , WEI Bing ³ , WANG Tengteng ¹ , LI Yuanbo ¹ , QIAN Kun ¹ , WANG Leiming ⁴ ,  WEI Xiuqin ⁵

1. Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;
2. Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;
3. Department of Pulmonary and Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;
4. Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;
5. Endoscopic Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, P. R. China;

Corresponding author：

WEI Xiuqin, Email: weixq8888@163.com

Keywords：

Bronchiolar adenoma; video-assisted thoracic surgery; imaging features; postoperative pathology

DOI：

10.7507/1007-4848.202102054

Video：

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Objective To analyze the pathological manifestations and imaging characteristics of bronchiolar adenoma (BA).Methods The clinical data of 11 patients with BA who received surgeries in our hospital from January 2019 to September 2020 were retrospectively analyzed, including 5 males and 6 females aged 40-73 (62.40±10.50) years. The intraoperative rapid freezing pathological diagnosis, postoperative pathological classification, cell growth pattern, nuclear proliferation index Ki-67 and other immunohistochemical staining combined with preoperative chest CT imaging characteristics were analyzed.Results The average preoperative observation time was 381.10±278.28 d. The maximum diameter of imaging lesions was 5-27 (10.27±6.34) mm. Eight (72.7%) patients presented with irregular morphology of heterogeneous ground-glass lesions, and 3 (27.3%) patients presented with pure ground-glass lesions. There were 10 (90.9%) patients with vascular signs, 8 (72.7%) patients with vacuolar signs, 1 (9.1%) patient with bronchus sign, 3 (27.3%) patients with pleural traction and 9 (81.8%) patients with burr/lobular sign. The surgical methods included sub-lobectomy in 10 patients and lobectomy in 1 patient. Five (45.5%) patients were reported BA by intraoperative frozen pathology. The postoperative pathological classification included 8 patients with distal-type and 3 patients with proximal-type, and the maximum diameter of the lesions was 4-20 (8.18±5.06) mm. Eight (72.7%) patients showed characteristic bilayer cell structure under microscope, and 10 (90.9%) patients showed thyroid transcription factor 1 expression in pathological tissues. The expression of NapsinA in intracavity cells was found in 9 (81.8%) patients. The Ki-67 index of the lesion tissue was 1%-5% (3.22%±1.72%).Conclusion The pathological features and imaging findings of BA confirm the premise that BA is a neoplastic lesion. However, to identify BA as a benign or inert tumor needs more clinical data and evidence of molecular pathological studies.

Citation： SU Lei, ZHANG Yi, GAO Yan, WEI Bing, WANG Tengteng, LI Yuanbo, QIAN Kun, WANG Leiming, WEI Xiuqin. Imaging characteristics and postoperative pathological analysis of bronchiolar adenoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 78-83. doi: 10.7507/1007-4848.202102054 Copy

1.	Chang JC, Montecalvo J, Borsu L, et al. Bronchiolar adenoma: Expansion of the concept of ciliated muconodular papillary tumors with proposal for revised terminology based on morphologic, immunophenotypic, and genomic analysis of 25 cases. Am J Surg Pathol, 2018, 42(8): 1010-1026.
2.	王恩华. 细支气管腺瘤: 易与癌混淆的良性肿瘤. 中华病理学杂志, 2019, 48(6): 425-432.
3.	Guo Y, Shi Y, Tong J. Bronchiolar adenoma: A challenging diagnosis based on frozen sections. Pathol Int, 2020, 70(3): 186-188.
4.	高何, 杜晓刘, 陈春妮, 等. 细支气管腺瘤 15 例临床病理学观察. 中华病理学杂志, 2020, 49(6): 556-561.
5.	Kataoka T, Okudela K, Matsumura M, et al. A molecular pathological study of four cases of ciliated muconodular papillary tumors of the lung. Pathol Int, 2018, 68(6): 353-358.
6.	牛传岭, 苗森, 陈雪, 等. 细支气管腺瘤一例. 中华病理学杂志, 2020, 49(9): 946-948.
7.	崔娜, 祝峙. 肺细支气管腺瘤 1 例. 临床与实验病理学杂志, 2021, 37(2): 251-252.
8.	张杰, 邵晋晨, 韩昱晨. 细支气管腺瘤病理诊断若干问题. 中华病理学杂志, 2020, 49(6): 529-533.
9.	苏雷, 张毅, 李元博, 等. 20~30 mm 磨玻璃肺结节的影像学特征及术后病理分析. 医学研究杂志, 2020, 49(11): 54-59.
10.	Yang C, Wang X, Da J, et al. Distal-type bronchiolar adenoma of the lung harboring an EGFR exon 21 p.L858R mutation: A case report. Thorac Cancer, 2020, 11(12): 3596-3598.
11.	Tachibana M, Saito M, Kobayashi J, et al. Distal-type bronchiolar adenoma of the lung expressing p16 INK4a-morphologic, immunohistochemical, ultrastructural and genomic analysis—Report of a case and review of the literature. Pathol Int, 2020, 70(3): 179-185.
12.	Kamata T, Sunami K, Yoshida A, et al. Frequent BRAF or EGFR mutations in ciliated muconodular papillary tumors of the lung. J Thorac Oncol, 2016, 11(2): 261-265.
13.	Jin Y, Shen X, Shen L, et al. Ciliated muconodular papillary tumor of the lung harboring ALK gene rearrangement: Case report and review of the literature. Pathol Int, 2017, 67(3): 171-175.
14.	Su L, Li Y, Wang T, et al. Synchronous multiple primary lung cancers with shared EGFR mutation but differential imaging findings and pathological subtypes: A case report. Respir Med Case Rep, 2020, 31: 101244.
15.	Udo E, Furusato B, Sakai K, et al. Ciliated muconodular papillary tumors of the lung with KRAS/BRAF/AKT1 mutation. Diagn Pathol, 2017, 12(1): 62.

1. Chang JC, Montecalvo J, Borsu L, et al. Bronchiolar adenoma: Expansion of the concept of ciliated muconodular papillary tumors with proposal for revised terminology based on morphologic, immunophenotypic, and genomic analysis of 25 cases. Am J Surg Pathol, 2018, 42(8): 1010-1026.
2. 王恩华. 细支气管腺瘤: 易与癌混淆的良性肿瘤. 中华病理学杂志, 2019, 48(6): 425-432.
3. Guo Y, Shi Y, Tong J. Bronchiolar adenoma: A challenging diagnosis based on frozen sections. Pathol Int, 2020, 70(3): 186-188.
4. 高何, 杜晓刘, 陈春妮, 等. 细支气管腺瘤 15 例临床病理学观察. 中华病理学杂志, 2020, 49(6): 556-561.
5. Kataoka T, Okudela K, Matsumura M, et al. A molecular pathological study of four cases of ciliated muconodular papillary tumors of the lung. Pathol Int, 2018, 68(6): 353-358.
6. 牛传岭, 苗森, 陈雪, 等. 细支气管腺瘤一例. 中华病理学杂志, 2020, 49(9): 946-948.
7. 崔娜, 祝峙. 肺细支气管腺瘤 1 例. 临床与实验病理学杂志, 2021, 37(2): 251-252.
8. 张杰, 邵晋晨, 韩昱晨. 细支气管腺瘤病理诊断若干问题. 中华病理学杂志, 2020, 49(6): 529-533.
9. 苏雷, 张毅, 李元博, 等. 20~30 mm 磨玻璃肺结节的影像学特征及术后病理分析. 医学研究杂志, 2020, 49(11): 54-59.
10. Yang C, Wang X, Da J, et al. Distal-type bronchiolar adenoma of the lung harboring an EGFR exon 21 p.L858R mutation: A case report. Thorac Cancer, 2020, 11(12): 3596-3598.
11. Tachibana M, Saito M, Kobayashi J, et al. Distal-type bronchiolar adenoma of the lung expressing p16 INK4a-morphologic, immunohistochemical, ultrastructural and genomic analysis—Report of a case and review of the literature. Pathol Int, 2020, 70(3): 179-185.
12. Kamata T, Sunami K, Yoshida A, et al. Frequent BRAF or EGFR mutations in ciliated muconodular papillary tumors of the lung. J Thorac Oncol, 2016, 11(2): 261-265.
13. Jin Y, Shen X, Shen L, et al. Ciliated muconodular papillary tumor of the lung harboring ALK gene rearrangement: Case report and review of the literature. Pathol Int, 2017, 67(3): 171-175.
14. Su L, Li Y, Wang T, et al. Synchronous multiple primary lung cancers with shared EGFR mutation but differential imaging findings and pathological subtypes: A case report. Respir Med Case Rep, 2020, 31: 101244.
15. Udo E, Furusato B, Sakai K, et al. Ciliated muconodular papillary tumors of the lung with KRAS/BRAF/AKT1 mutation. Diagn Pathol, 2017, 12(1): 62.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Imaging characteristics and postoperative pathological analysis of bronchiolar adenoma

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