A case of true pulmonary carcinosarcoma]

The patient was a 47-year-old man who had visited a nearby physician with a chief complaint of bloody sputum. This patient underwent partial resection of the left upper lobe including a tumor adjacent to a huge bulla revealed by a plain chest radiograph. The resected tumor was composed of adenocarcinomatous and sarcomatous components, including partially-differentiated chondrosarcoma and rhabdomyosarcoma. The diagnosis was therefore true pulmonary carcinosarcoma. The sarcoma component recurred in the remaining part of the left lung. This recurrent lesion was surgically unresectable, but was regionally controlled with radiotherapy and bronchial arterial infusion of anticancer agents. However, distant metastases occurred to the brain, liver, and small intestine, and digestive tract bleeding also occurred. Nevertheless, chemotherapy, linac radiosurgery, percutaneous radiofrequency ablation, and partial small intestinal resection combined with rectal resection were performed. At autopsy, a metastatic lesion was also detected in the pancreas. Liver metastatic lesions were determined to be the adenocarcinomatous component, and the other recurrent or metastatic lesions, except for those in the brain, were all composed of poorly-differentiated sarcomatous tissue.     

A case of carcinosarcoma of the lung]

A 78-year-old man was admitted to our hospital with cough and left anterior chest pain. Chest X-ray examination on admission revealed a tumor shadow in the left upper lobe. Malignant tumor cells were observed on histopathological examination of a specimen obtained by bronchoscopic biopsy. Radiotherapy was performed but was not effective, and the patient died of respiratory failure 4 months after admission. Autopsy revealed a 15 cm diameter tumor with marked local invasion tendency without distant metastasis. Microscopically, the tumor consisted partly of squamous cell carcinomas, and partly of fibrosarcomas, composed of spindle cells and osteo-chondrosarcoma. The tumor was therefore diagnosed as carcinosarcoma. Immunohistochemical examination showed positive keratin and EMA staining only in the squamous cell carcinoma component of the tumor.     

A case of true pulmonary carcinosarcoma]

A 72-year-old male was admitted to our hospital because of dyspnea. A chest radiograph showed a mass shadow measuring 40 x 40 mm in the left lower lobe, and fiberoptic bronchoscopy revealed obstruction of the left B8 by the tumor. Adenocarcinoma was suspected after a transbronchial biopsy, and left lower lobectomy was performed. Histologically, the resected specimen was composed of carcinomatous and sarcomatous elements, and further immunohistological study revealed that the former component was poorly differentiated squamous cell carcinoma and the latter was fibrosarcoma. We therefore concluded that the tumor was a true carcinosarcoma of the lung.     

Infection of submucosal tumor after endosonography-guided needle biopsy]

Endosonography fine needle guided aspiration (EUS-FNA) biopsy is an interesting technique for the diagnosis of suspected gastrointestinal lesions, and is rarely complicated by infection. We report one case of severe infection after EUS-FNA of benign oesophageal leiomyoma, leading to an oesophagectomy. Recent studies about this technique described only infectious complications after biopsy of cystic lesions. They also show that EUS-FNA may misdiagnose leiomyosarcoma. Our report confirms these data, and relates a hitherto non-reported complication, i.e. the infection of a non-cystic lesion.     

CT引导下经皮肺穿刺活检在肺部占位病变中的诊断价值

目的探讨CT引导下经皮肺穿刺活检对肺部占位病变的诊断价值。方法CT扫描确定最佳的穿刺点、局麻后CT引导下组织切割针经皮刺入到病灶,切割组织行病理检查。结果56例肺占位病变行CT引导下经皮肺穿刺活检,53例得到确诊,阳性率为94.6%。并发症包括少量气胸11例,肺出血9例,少量咯血5例,均不需特殊处理。结论CT引导下经皮肺穿刺活检对肺占位病变的诊断阳性率高、并发症轻,值得临床推广。     

A case of pulmonary carcinosarcoma with abnormal uptake in bone scintigraphy]

A 68-year-old man was admitted to our hospital with abnormal chest radiograph shadows. Chest CT showed a large mass with calcification in the right lower lobe. Bone scintigraphy revealed abnormal uptake by the tumor. The biopsy specimen obtained by bronchoscopy and fine-needle aspiration demonstrated no malignancy, and chest radiographs obtained two years before were normal. Right lower lobectomy was performed. Histologically, the tumor was composed of squamous cell carcinoma and osteosarcoma, and the diagnosis was true carcinosarcoma of the lung.     

Intrapulmonary recurrence after computed tomography-guided percutaneous needle biopsy of stage I lung cancer

Tumor seeding, along the needle tract after percutaneous needle biopsy, is a rare condition and most of the reported cases are implantation metastasis, which occurred in the chest wall or the pleura. We present a case of implantation metastasis that occurred in the pulmonary parenchyma, after a computed tomography-guided percutaneous needle biopsy (CT-PNB) of stage I lung cancer.     

CT引导下经皮肺细针抽吸活检对肺周围性病变的诊断价值

目的 评价CT引导下经皮肺细针抽吸活检术在肺内病变中的诊断价值.方法 回顾性分析165例行CT引导下经皮肺细针抽吸活检术的肺内周围性病变资料.结果 经手术、病理及临床随访证实恶性肿瘤114例,良性病变51例.穿刺病理恶性108例,准确率为94.7%,假阴性6例,无假阳性;良性病变41例,准确率为80.4%,穿刺总准确率为90.0%.发生并发症11例,发生率为7.0%,其中气胸4例,少量肺出血2例,肋间神经痛1例.结论 CT引导经皮肺细针抽吸活检术是一种微创、准确度较高、并发症较少的有效检查方法,有助于肺部病变的诊断与鉴别诊断,具有较高的临床价值.     

A case of acute cholecystitis secondary to hemobilia after percutaneous liver biopsy]

Percutaneous liver biopsy is well established for the diagnosis and follow-up of many liver diseases. Although it is rather safe, major complications, such as bleeding into the peritoneal or thoracic cavity, hemobilia, enteric perforation and intrahepatic hematoma, have been reported related to the procedure. Recently, incidence of such major complications has been decreased since the introduction of ultrasonography-guided liver biopsy. We report a case of 59-year-old female patient with acute cholecystitis secondary to hemobilia 2 days after ultrasonography-guided percutaneous liver biopsy.     

The factors determining diagnostic accuracy in CT-guided percutaneous needle biopsy of small pulmonary nodules]

Between February 1997 and March 1999, 79 consecutive CT-guided automated needle biopsy procedures were performed in 78 patients (79 small pulmonary nodules measuring 20 mm or less in diameter). In 69 (87%) of 79 lesions, sufficient material for histologic diagnosis was obtained. We evaluated the factors affecting diagnostic accuracy in CT-guided automated needle biopsy. Lesion diameter, depth from skin, chronic pulmonary disease and location were analyzed. The diameter of the lesion was a significant factor contributing to diagnostic accuracy (p = 0.0108). Pneumothorax occurred in 18 cases (23%). In 5 cases (6%), chest tube placement was necessary. Postbiopsy hemoptysis or hemosputum occurred in 23 cases (29%). In conclusion, lesion diameter was a critical factor in diagnostic accuracy. CT-guided automated needle biopsy is a feasible, useful and safe technique for the histological diagnosis of small lung lesions, but especially those larger than 8 mm in diameter.     

经皮肺穿刺诊断肺透明变性肉芽肿病一例

<正>肺透明变性肉芽肿病或译作肺玻璃样变性肉芽肿病(pulmonary hyalinizing granuloma,PGH)是少见的肺部结节性疾病,既往文献也多为个案报道。本文回顾文献并结合本中心的1例肺透明样变性肉芽肿病患者的临床表现、诊治经过、随访表现等,探讨肺透明样变性肉芽肿病诊断及治疗、预后。本例患者为国内医疗机构第6例报道,也为唯一1例由经皮肺穿刺病理确诊、有明确随访资料的病例。     

Case of pulmonary tumor thrombotic microangiopathy diagnosed by transbronchial lung biopsy]

A 69-year-old man was admitted to our hospital with dyspnea on effort. A chest high resolution CT showed enlargement of peripheral vessels and small nodules in both lower and peripheral lung fields. We diagnosed this case as pulmonary tumor thrombotic microangiopathy, because histological findings of specimen obtained by transbronchial lung biopsy revealed microscopic tumor emboli and intimal proliferation in small pulmonary vessels. After conducting systemic examinations, it was found that the patient had gastric cancer. Generally it is difficult to diagnose pulmonary tumor thrombotic microangiopathy in patients during life. To the best of our knowledge, this is the first case of pulmonary tumor thronbotic microangiopthy diagnosed on the basis of transbronchial lung biopsy.     

A case of gastric metastasis from small cell lung carcinoma]

Gastric metastasis of lung carcinoma is a rare entity which is detected mostly at autopsy. Patients diagnosed as having those on lifetime are extremely rare. In addition to our case, 54 cases of lung carcinoma metastasis to the gastro-intestinal tract have been reported in the literature since 1961. We report a case of gastric metastasis originated from small cell lung carcinoma. The patient was a 87-year-old man. He refused lung biopsy and further treatment and died 2 months after the diagnosis. This is the case of gastric metastasis originated from lung carcinoma, which was confirmed by immunohistochemical staining.     

Diagnostic value of computed tomographyguided percutaneous needle biopsy versus radial probe endobronchial ultrasound-guided transbronchial lung biopsy in peripheral pulmonary lesions

<正>Objective To evaluate the value of computed tomography-guided percutaneous needle biopsy(CT-PNB)and radial probe endobronchial ultrasound-guided transbronchial lung biopsy(EBUS-TBLB)in the diagnosis of peripheral pulmonary lesions(PPLs).Methods The clinical data of 213 patients who were diagnosed as to     

多种活检在周围型肺癌诊断中的应用

目的研究CT引导下经皮肺活检（CT-PLB）与经支气管镜肺活检（TBLB）或经支气管针吸活检（TBNA）在周围型肺癌诊断中的应用。方法对143例周围型肺癌患者的诊断方法进行分析,其中137例通过单用或联合采用CT-PLB、TBLB、TBNA等检查手段取得病理学诊断,6例为术后病理学诊断。结果 CT-PLB确诊率为85.4%,TBLB确诊率为68.4%,TBNA确诊率为80%,联合应用总确诊率为95.8%。结论对于肺周围型病变,根据病灶大小、位置、与胸壁距离、有否纵隔淋巴结转移等具体情况选择合适的活检方式可取得病理学诊断,多种方法联合应用可提高检出率。