肺原发性脑膜瘤4例临床病理分析OA

Objective To investigate the clinicopathological features,immunophenotypes,and biological behav-iors of primary pulmonary meningioma(PPM).Methods Clinical data from 4 cases of PPM were collected.Immuno-histochemistry was performed to analyze the immunophenotype.Molecular pathology was conducted to detect gene mu-tation status,and relevant literatures were reviewed.Results Among the 4 patients,there were 3 males and 1 fe-male,with a mean age of 58 years.One case presented multifocal lesions and was complicated with peribronchial lymph node metastasis.The patient died of renal metastasis 5 years after surgery.The other three cases had no postop-erative recurrence and showed a favorable prognosis.Morphologically,in case 1,some tumor areas resembled menin-gothelial meningioma of the central nervous system(CNS).Tumor cells were arranged in nests or whorls,with abun-dant cytoplasm and ill-defined cell borders.The nuclei were round or oval,with distinct nuclear membranes,pale chromatin,and small nucleoli.Nuclear grooves and intranuclear inclusions could be observed.Focal mitoses were more than 4 per 10 HPF.The tumor grew invasively in lung tissue.Similar tumor lesions could be observed in chest wall nodules,diaphragmatic nodules,and peribronchial lymph nodes.The other three cases showed bland morphology and low Ki67 proliferation index.Immunophenotypically,tumor cells of all 4 cases expressed vimentin,PR,EMA,SSTR-2,and CD99.The Ki67 proliferation index of case 1 reached 10%,while the Ki67 index of the remaining 3 cases was less than 5%.Case 1 carried higher risks of invasion and metastasis.Next-generation sequencing(NGS)testing showed that no gene mutations of CDKN2A,CDKN2B,CDKN2C,EGFR,MDM2,MDM4,and NF2 were de-tected in case 1.Molecular tests of cases 2-4 showed that no TERT or CDKN2A gene mutations were identified.Con-clusion PPM is extremely rare,and mostly lesions are benign,so regular follow-up is sufficient after surgical resec-tion.Multifocal PPM combined with metastasis to other organs is even rarer,and the diagnosis requires a comprehen-sive analysis combining clinical history,histopathological features,immunophenotype,and molecular detection.