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目的 观察和分析肺鳞状上皮不典型增生 /原位癌 (SD/CIS)的病理形态特点 ,为肺癌前病变的早期临床诊断提供依据。方法 收集 36 0例手术切除的肺癌和肺炎性大体标本 ,HE染色 ,显微镜下寻找各级增生病变 ,观察和分析SD/CIS的病理形态特点。结果 肺癌组轻、中度不典型增生病变的发生率为 2 3 9%(5 5 /2 30 )、重度不典型增生 /原位癌 34 8%(80 /2 30 ) ;在肺炎性组 ,轻度不典型增生病变的发生率为 9 2 %(12 /130 ) ,无一例中、重度不典型增生 /原位癌病变。 5 4 4 %(80 /147)的鳞状上皮不典型增生病变覆盖原有的支气管上皮细胞。SD/CIS的生长方式有两种 ,86 3%(6 9/80 )为“蔓延型”生长 ,16 3%(13/80 )为“假浸润型”生长。结论 SD/CIS主要存在于肺癌旁的各级支气管上皮。支气管上皮的SD/CIS不同于食管和宫颈等部位的癌前病变。依据WHO的分类标准 ,难以将覆盖支气管上皮的SD/CIS分级。实践中可以忽略覆盖在不典型增生病变之上的呼吸道上皮 ,只考虑鳞状上皮不典型增生病变 ,将SD/CIS分为“低级”和“高级”两种病变。
Objective To observe and analyze the pathological features of lung squamous cell dysplasia / carcinoma in situ (SD / CIS) and provide basis for early clinical diagnosis of lung precancerous lesions. Methods 360 cases of resected lung cancer and pneumonia were collected and stained with hematoxylin-eosin (HE). The pathological changes of SD / CIS were observed and analyzed under microscope. Results The incidence of mild and moderate atypical hyperplasia of lung cancer group was 23.9% (5/2/30) and severe atypical hyperplasia / carcinoma in situ was 34.8% (80/230). In the group of lung inflammation, The incidence of mild dysplasia was 92% (12/130), and in none of the cases, severe dysplasia / carcinoma in situ was found. Fifty-four (80%) of 147 patients with atypical hyperplasia of squamous epithelium covered the original bronchial epithelial cells. There were two kinds of growth modes for SD / CIS, 86 3% (69/80) for “sprawling” and 16 3% (13/80) for “spurious infiltration”. Conclusion SD / CIS mainly exists in the bronchial epithelium beside lung cancer. Bronchial epithelial SD / CIS is different from esophageal and cervical precancerous lesions. According to the WHO classification criteria, it is difficult to grade the SD / CIS covering the bronchial epithelium. In practice, the respiratory epithelium covering the atypical hyperplasia lesions can be ignored and only the atypical hyperplasia of squamous epithelium is considered. SD / CIS is divided into two types: “low” and “advanced”.