[Pathological characteristic and clinical management of pulmonary carcinoid]

Abstract

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.

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肺类癌的病理表现。A：肺典型和不典型类癌中最常见的器官样结构生长方式。肿瘤细胞较一致，胞浆中等量，嗜酸性，核呈细颗粒状（HE, ×40）；B：肺非典型类癌可出现灶状坏死（HE, ×40）；C：免疫组化显示类癌嗜铬素A阳性（×40）；D：本例典型类癌Ki-67指数约为2%（×40）；E：本例不典型类癌Ki-67指数约为10%（×40）；F：本例类癌组织学形态类似硬化性血管瘤（HE, ×40）。 The pathological pattern of lung carcinoid. A: An organoid growth pattern is the most common histologic pattern in both typical and atypical carcinoid. Tumor cells have uniform cytologic features with a moderate amount of eosinophilic cytoplasm. Nuclear features usually consist of finely granular chromatin; B: The necrosis usually consists of small punctate foci in atypical carcinoid; C: Imunohistochemistry shows chromogranin A is positive in carcinoid; D: The Ki-67 index in carcinoid is lower; E: The Ki-67 index in atyical carcinoid is higher; F: The morphology in carcinoid is similar as sclerosing hemangioma.