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目的探讨煤矽肺并发肺癌的临床病理特点。方法对16例生前诊断为尘肺0+的煤尘接触工人并发肺癌者的尸检资料采用HE、组织化学、免疫组化染色进行回顾性分析。结果16例患者均为男性,年龄46～57岁(平均52.8岁),尸检肺内可见不同程度的煤尘沉积和煤尘纤维灶,煤矽结节检出率为93.75%(15/16),15例病理诊断为Ⅰ期煤矽肺,1例为煤矽尘性反应;16例肺癌中鳞状细胞癌5例、小细胞未分化癌5例、肺泡细胞癌3例、腺癌2例、腺鳞癌1例。煤矽肺并发肺癌最明显的特点是癌组织位于煤尘纤维灶和纤维化病变旁或与尘肺病变混合存在。免疫组化结果除2例未分化癌表达神经源性标记外,余均表达上皮性标记物。波形蛋白可显示纤维成分。结论部分肺癌的发生可能与纤维化病变有关。接尘工人可患与普通人群组织学类型相同的癌。PCNA和Ki67可作为预测患者预后的指标,波形蛋白可作为煤尘纤维灶中纤维成分的标记物。
Objective To investigate the clinicopathological features of coal silicosis complicated with lung cancer. Methods The autopsy data of 16 cases of pneumoconiosis exposed to dust and pneumoconiosis diagnosed by pneumoconiosis 0+ were retrospectively analyzed by HE, histochemistry and immunohistochemistry. Results All the 16 patients were male, aged 46-57 years (mean 52.8 years). Different degrees of coal dust deposition and coal dust were observed in the lung of autopsy. The detection rate of coal silicon nodules was 93.75% (15/16) , 15 cases of pathological diagnosis of stage Ⅰ coal silicosis, 1 case of coal dust reaction; 16 cases of lung squamous cell carcinoma in 5 cases, 5 cases of small cell undifferentiated carcinoma, alveolar cell carcinoma in 3 cases, adenocarcinoma in 2 cases, A case of adenosquamous carcinoma. The most obvious feature of coal silicosis complicated with lung cancer is that the cancer tissue is located beside the coal dust fibrosis and fibrosis or mixed with pneumoconiosis. Immunohistochemical results in addition to two cases of undifferentiated carcinoma expression of neurogenic markers, I still expressed epithelial markers. Vimentin can show the fiber composition. Conclusion The occurrence of lung cancer may be related to fibrosis. Workers exposed to dust may suffer from cancers of the same histological type as the general population. PCNA and Ki67 can be used as an index to predict the prognosis of patients, and vimentin can be used as a marker for fiber components in coal dust fibrin.