An Analysis Of Clinical Features Of Patients With Primary Low-grade Malignant Tumors Of The Lung

Objective To analyze the clinical features,imaging,bronchoscopy and other clinical features of patients with primary low-grade malignant tumors of the lung,including pulmonary carcinoid(PC),pulmonary adenoid cystic carcinoma(PACC)and Pulmonary mucoepidermoid carcinoma(PMEC),as well as treatment methods and prognosis,in order to provide reference for early detection and timely treatment of the clinic,thereby reducing clinical misdiagnosis,missed diagnosis and improving prognosis.Methods According to the inclusive criteria and exclusive criteria,a retrospective analysis of clinical records of 48 patients with primary low-grade lung malignancies diagnosed by pathology from January 2002 to May 2018 in General hospital of ningxia medical university.The patient’s gender,age,smoking history,onset time,clinical symptoms at the time of treatment,chest CT findings,bronchoscopy findings,pathological results,diagnosis methods,staging conditions,treatment methods,follow-up results,etc.were summarized and the results were discussed.Results 1.General condition:(1)The ratio of male to female was 1:1.4.The age of onset was from 30 to 73 years old,and the average age of onset was 53±11 years old.(2)The course of disease varies from 1 week to 11 years,with an average duration of about 13 months.(3)Among them,there were 30 cases of PC,accounting for 62.50%.PACC accounts for20.83%,and PMEC accounts for 16.67%.There are 20 cases of typical carcinoid(TC)in PC and 10 cases of atypical carcinoid(AC).(4)Seven cases of this study were misdiagnosed in the study,and the misdiagnosis rate was 14.58%.2.The mainly clinical symptom was cough,a total of 37 cases,accounting for 77.08%.In addition,8 patients(16.67%)had no symptoms.3.Tumor growth site: This data is more common in the central type,a total of 30 cases(62.50%),18 cases around(37.50%).respectively.The proportions of PC,PACC and PMEC occurring in the central airway(trache,left and right main bronchus,or both)were 13.33%(4/30),70%(7/10),and 37.5%(3/8),respectively.It was found that the proportion of PACC in the central airway was higher than that of PC and PMEC,and the proportion of PMEC was higher than that of PC.The difference was statistically significant.4.Auxiliary inspection :(1)In some patients,tumor markers may have different degrees of elevation,but no specificity.(2)CT findings were diverse,with 25 cases of round nodules,accounting for 52.08%(25/48),19 cases of soft tissue masses,39.58%(19/48),and 1 case of ground glass nodules,2.08%(1/48).Right middle lobe atelectasis,bronchiectasis,right middle lobe atelectasis with bronchial truncation,each proportion was 2.08%(1/48).Some have lobulation sign,burr sign and pleural indentation.36 patients underwent enhanced CT examination,and 58.33%(21/36)of patients had different degrees of enhancement.(3)38cases(79.17%)underwent bronchoscopy,there were 29 new organism,2 cases of luminal mucosal hypertrophy and stenosis,1 case of extraluminal stenosis,and 6 cases of no abnormalities.26 cases were biopsy and 18 cases were positive.24 cases were brushed and 1case was positive.25 cases were lavaged and 2 cases were positive.(4)The immunohistochemical performance of 28 PCs in this study: the positive expression rates of CgA,Syn,CD56,NSE and TTF-1 were 88.46%,92.59%,96%,100% and 39.29%,respectively.The Ki-67 proliferation index was between 1% and 30%.Ki-67 of TC was ≤10%,and Ki-67 of AC was up to 30%.There was a significant difference in the positive expression of Ki-67 between TC and AC(P=0.012).The Ki-67 proliferation index of PACC was between10% and 30%,and the Ki-67 of PMEC is≤20%.5.Staging situation: Among them,stage I accounted for 58.33%(28/48),and stage IIIB andabove accounted for 18.75%(9/48).The proportion of stage I in PC group was higher than that in primary lung parotid gland tumor group(PACC+PMEC),the difference was statistically significant(P <0.05).The proportion of stage IIIB and above in the primary pulmonary parotid tumor group(PACC+PMEC group)was higher than that in the PC group(P <0.05).PC is earlier than the stage of diagnosis of the primary pulmonary parotid tumor.6.Treatment and prognosis: 36 cases were surgically operated,the pathological stage was IA-IIIB stage,The 5-year and 10-year survival rates of 30 patients after surgery were 95% and83.1%,respectively.Twelve patients with stage IB-IV had no surgery.Eight of them had a survival period of 4 to 59 months,and a 5-year survival rate of 0%.Bronchoscopy intervention in 7 cases,accounting for 14.58%.The rest of the main palliative care is radiotherapy and chemotherapy.Conclusions :1.Primary low-grade malignant tumors of the lungs are rare and usually occur in women.The average age of onset is smaller than that of bronchogenic carcinoma.2.Among them,PC is the most common.The clinical symptoms are lack of specificity,and the growth site of the tumor is mainly central,Among them,PACC and PMEC are mostly seen in the central type,while PC central type and peripheral type are both visible.3.The chest CT is mainly composed of nodules and masses.The central type of bronchoscopy is mainly neoplasm and needs to be differentiated from bronchogenic carcinoma.4.For primary low-grade malignant tumors,early surgery has a good prognosis.