胸膜孤立性纤维瘤的诊治

目的 探讨胸膜孤立性纤维瘤的诊断和治疗方法.方法 回顾性分析2002年至2007年10例胸膜孤立性纤维瘤病人的临床和病理资料.10例中男3例,女7例.术前行超声引导下粗针穿刺活检明确诊断2例.全组均行手术治疗,其中3例行胸腔镜手术切除.结果 组织病理学报告,良性和恶性肿瘤各5例;恶性肿瘤CD34表达阳性率较低(3/5例),其中CD34阴性者nestin表达均阳性.失访1例,其余9例随访6～35个月,平均17.3个月,复发1例,死于脑转移1例.结论 超声引导下粗针穿刺结合免疫组化检查是术前明确诊断的一种较好方法.对于较小带蒂的肿瘤,胸腔镜手术是最佳手术方法.CD34阴性,同时nestin表达阳性可能是胸膜孤立性纤维瘤的一个恶性指标.

Clinical and pathological analysis of solitary fibrous tumor of the pleura

Objective To investigate appropriate diagnosis and treatment of solitary fibrous tumor of the pleura (SFTP).Methods Clinical and pathological data of ten patients treated in our hospital from 2002 to 2007 were reviewed. Results Our series consisted of three men and seven women. In two patients correct diagnosis was made before operation through ultrasonography-gnided core needle biopsy. All the patients were treated surgically including three resected by video-assisted thoracic surgery (VATS). Histopathologically, five tumors were malignant and the other five were benign. Immunohistochemical staining showed malignant SFTP (3/5) were less frequently positive for CD34 than benign group (5/5). Nestin was only detected in malignancies (2/5), which were negative for CD34. Except for one, all patients were followed-up for 6 to 35 months (mean 17.3 months). One patient experienced a recurrence and one died of brain metastasis. Conclusion Ultrasonography-guided core needle biopsy combined with immunohistochemical analysis is a safe and rapid method to provide a confirmatory diagnosis before surgery. For smaller, pedunculated tumors, VATS may be a bettor approach. Besides, we speculated CD34-negative and nestin-posifive might be a malignant marker for SFTP.