肺类癌的病理特质与临床决策

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. CONCLUSION: Pathological diagnosis of pulmonary carcinoid must combine morphology with immunohistochemistry. Early-stage patients can also achieve good effect after surgery.