成人胸腔巨大梭形细胞横纹肌肉瘤1例报道并文献复习

<正>横纹肌肉瘤(rhabdomyosarcoma, RMS)是起源于中胚叶原始干细胞的软组织肉瘤，属于高度恶性肿瘤，常见于儿童及青少年，成人RMS十分罕见[1]。绝大部分原发病灶位于头颈、四肢、躯干、臀及肩胛等肌肉丰富的部位，而原发于肺或胸膜少见[2],易被误诊为胸膜间皮瘤、大量胸腔积液及孤立性纤维性肿瘤等，本文回顾性分析1例胸腔梭形细胞横纹肌肉瘤的临床特点、免疫表型特征及诊治经过，并复习相关文献，以提高临床对胸腔横纹肌肉瘤的认识水平。     

原发性肺滑膜肉瘤诊断与治疗附1例报告及文献复习

目的 通过探讨原发性肺滑膜肉瘤的临床症状、影像学表现、病理学及免疫组化,提高对本病的认识.方法 报告近期呼吸科确诊1例原发性肺滑膜肉瘤患者,同时对既往报道18例患者进行回顾性研究,分析其临床表现、影像学表现、病理学特征及免疫组化特点.结果 临床表现为咳嗽、咳痰或胸痛、胸闷等,影像学表现为肺部肿块影,边缘清楚或呈分叶状,病灶密度不均匀,增强扫描呈不均匀强化,可伴纵隔淋巴结肿大及胸腔积液,病理学检查提示为梭形细胞恶性肿瘤,瘤细胞呈流水状排列,核分裂象易见,免疫组化EMA、Bcl-2、Vimentin等阳性.结论 原发性肺滑膜肉瘤临床表现及影像学表现上无特异性,不易与其他肺或胸膜原发性肉瘤相鉴别,需要结合病理及免疫组化结果进行诊断.     

经皮椎体成形术致骨水泥肺栓塞1例报告

临床资料患者,女,52岁。因“外伤后背部疼痛20天”于2018年9月2日入院。20天前患者劳动时不慎扭伤胸背部,背部疼痛明显,一直无缓解,来我院行胸椎MRI,提示胸10椎体新鲜骨折,骨密度检查提示骨质疏松,遂以“胸椎骨折”收入院。入院查体:胸椎棘突及椎旁压痛明显,叩击痛阳性,屈伸旋转活动受限。双下肢运动、感觉、反射正常,生理反射正常,病理反射未引出。入院后查血常规、血生化、凝血功能及X线胸片未见异常。于2018年9月4日在局麻下行胸10椎体压缩性骨折后路椎体成形术,术中在C臂定位及交替透视下经胸10右侧椎弓根穿刺进入胸10椎体中前份,调和骨水泥至起丝期后经右侧注入胸10椎体3.2mL。C型臂透视下监测骨水泥弥散可,骨水泥硬定后拔出穿刺针。整个手术过程患者无特殊不适。术后患者背痛明显减轻,余无特殊不适。术后第2天常规复查胸椎片,提示胸10椎体骨折椎体成形术后,椎体形态可,椎体内见斑片状密度影,双肺散在条片状高密度影(图1)。双肺散在条片状高密度影考虑骨水泥肺栓塞,建议胸部CT检查,患者拒绝出院。2018年11月23日患者来院骨科复查,胸椎片提示胸10椎体骨折椎体成形术后,双肺野散在条片状高密度影,较2018年9月5日片比较无明显变化。骨科因肺部病变请呼吸科会诊,笔者结合患者手术病史,考虑骨水泥肺栓塞,行胸部CTPA检查,结果提示:1)胸10椎体骨折椎体成形术后改变,相邻椎旁见一条高密度血管影,考虑骨水泥充填。2)双侧肺动脉分支内条片状高密度影充填,考虑骨水泥(图2)。     

病理确诊的肺隐球菌病38例临床分析

目的 探讨肺隐球菌病的临床特点、影像学表现、病理特征、治疗方法及预后。方法收集南京军区福州总医院2003年3月至2010年2月经病理确诊的38例肺隐球菌病患者的临床资料,并对相关资料进行分析。结果 38例均为社区获得性肺炎,其中男29例,女9例,年龄21～70岁,平均(47±13)岁。38例中伴基础疾病者9例。流式细胞分析CD4细胞正常20例。影像学表现：35例病变靠近胸膜,以下肺部受累多见,其中左下肺21例,右下肺23例;单发结节影11例,多发结节影16例,多发斑片状影3例,肿块伴多发结节5例,弥漫性肺实质浸润影3例;4例患者行18F-脱氧葡萄糖正电子发射计算机断层显像(PET-CT)检查,病灶均有较高的标准化摄取值（SUV值）。经皮肺穿刺活检确诊33例,开胸手术确诊1例,胸腔镜手术确诊3例,淋巴结活检确诊1例。治愈34例,显效3例,死亡1例。结论 在门诊就诊的肺部阴影患者中,肺隐球菌病应作为诊断及鉴别诊断的疾病之一。肺隐球菌病的影像学表现具有病灶多发、靠近胸膜及多位于下肺部等特点,但临床表现无特异性。经皮肺穿刺活检是确诊的有效方法之一。     

尿激酶治疗结核性包裹性胸积液后外科手术治疗的疗效分析

目的探讨在结核性包裹性胸积液疾病治疗中如何选择胸腔内注入尿激酶与外科手术治疗。方法分析我院651例诊断结核性包裹性胸积液病例,在入院后予常规抗痨治疗并予胸腔内注入尿激酶治疗,对有效组与效果不佳再转入外科行胸腔纤维板剥脱术治疗的手术组的疗效进行对比分析。结果两组病例的发病病程、复发率比较无明显差异(P0.05),在体查及B超、CT检查、胸腔穿刺或置管后肺能否复张比较有明显差异(P0.05)。结论在体查、B超和CT检查有阳性结果、胸腔穿刺或置管后肺不能复张的病例选择外科手术治疗效果较好,胸膜纤维板剥脱术仍是治疗胸膜增厚的结核性包裹性胸积液的有效方法。     

尿激酶治疗结核性包裹性胸积液后外科手术治疗的疗效分析肖泽林 刘家杰 高健齐 连贵勇简

目的 探讨在结核性包裹性胸积液疾病治疗中如何选择胸腔内注入尿激酶与外科手术治疗.方法 分析我院651例诊断结核性包裹性胸积液病例,在入院后予常规抗痨治疗并予胸腔内注入尿激酶治疗,对有效组与效果不佳再转入外科行胸腔纤维板剥脱术治疗的手术组的疗效进行对比分析.结果 两组病例的发病病程、复发率比较无明显差异 （P〉0.05）,在体查及B超、CT检查、胸腔穿刺或置管后肺能否复张比较有明显差异（P＜0.05）.结论 在体查、B超和CT检查有阳性结果、胸腔穿刺或置管后肺不能复张的病例选择外科手术治疗效果较好,胸膜纤维板剥脱术仍是治疗胸膜增厚的结核性包裹性胸积液的有效方法.     

结核性胸腔积液和恶性胸腔积液的CT影像特点

分析51例结核性胸腔积液及62例恶性胸腔积液患者的CT影像特点。结果显示，胸膜结节状增厚、大量胸液、纵隔移位、肺内团块或结节影、支气管狭窄或堵塞是恶性胸腔积液的影像特点；包裹性胸液、肺内片状或条索状影以结核性胸腔积液多见。提示CT检查可作为鉴别结核性与恶性胸腔积液的首选方法，指导进一步的诊断。     

肺泡蛋白沉着症误诊为肺炎一例

患者，男性，41岁。因胸部CT检查发现双肺多发片状影，于2008年10月27日入住我院。门诊查胸部CT结果提示：左肺上叶舌段、右肺中叶可见斑片状稍高密度影灶，边缘清，病灶分布以上肺及内带肺野为主，肺门不大，双肺胸膜无增厚（见图1）。入院时患者无任何临床症状，根据我院的条件，当时做相关辅助检查，如血尿粪三大常规、血沉、肺部肿瘤标志物测定、PPD试验、免疫球蛋白测定、乙肝三系、梅毒螺旋抗体和HIV抗体等结果均正常。     

胸腔穿刺诱发癫痫发作1例报告

胸腔穿刺既是诊断、又是治疗的重要手段。据文献报道,部分患者发生气胸、血胸、胸膜反应、感染、麻醉意外等不良反应,但诱发癫痫报道少见,本院自2008年～2010年间胸腔穿刺患者中,诱发1例癫痫发作,报道如下。病例报告患者男,28岁,未婚。因反复发热、咳嗽、气促1＋月于2010年2月10日入院。患者及家属均未诉既往有癫痫病史。入院后行胸片、彩色多普勒超声检查（彩超）示：右侧胸腔大量积液。为了明确胸腔积液的性质,找到病因,     

纤维支气管镜替代胸腔镜检查治疗5例报告

胸腔镜检查可使疑难胸膜疾病得到确诊 ,我们从 1998年 6月至 2 0 0 0年 5月对 5例病人进行了纤维支气管镜替代胸腔镜检查 ,现报告如下 :1　临床资料例 1:男 ,2 2岁 ,左上肺空洞性结核 2年余伴左侧液气胸 2月 ,已作胸腔闭式引流 ,持续负压吸引效果不佳。例 2 :男 ,40岁 ,3月来发生右侧气胸 3次 ,胸片示右肺压缩约 40 %。例 3,例4二例胸片示右侧中等量胸水 ,正规抗痨 ,激素 ,胸腔穿刺等治疗无好转。入院后给予胸水脱落细胞 ,胸膜活检检查仍未确诊。例 5 :女 ,37岁 ,有肺结核病史胸片见左侧气胸 ,肺压缩 5 0 % ,经胸腔闭式引流及胸腔负压吸引 (…     

胸膜孤立性纤维性肿瘤10例临床病理观察及文献复习

目的探讨胸膜孤立性纤维性肿瘤(SFT)的临床病理特征,提高对其临床及病理改变的认识。方法对10例胸膜SFT的临床资料和组织学形态进行回顾性分析,并采用免疫组织化学染色(Envision法)研究其形态及免疫表型特点。结果 10例患者中,男性6例,女性4例,发病年龄47~76岁,平均57.5岁。肿瘤分别位于脏层胸膜(4例),壁层胸膜(4例),叶间裂(2例),患者多因咳嗽,胸痛,胸膜腔肿块,肺部肿块就诊。影像学多显示:占位性病变和软组织团块影,其中2例显示有胸腔积液。病理组织学显示:肿瘤界限清晰,由交替性分布的细胞丰富区及稀疏区组成,部分可有粘液变。免疫组织化学显示:梭形细胞表达Bcl-2、CD34和vimentin。结论 SFT是一种较为少见的间叶性梭形细胞肿瘤,好发于胸膜。其确诊主要依赖于病理组织形态学及免疫组织化学染色。完整的手术切除是临床治疗SFT的必要手段,但少数SFT生长活跃,具有侵袭性,需长期随访。     

A case of M. fortuitum lung disease with small-cell lung cancer]

A 58-year-old man was admitted to our hospital because of an abnormal shadow found on chest radiography. Chest radiographs and chest CT on admission showed a bulla with a niveau and infiltration in the right upper lobe. Smear of sputum and bronchial lavage were negative for acid-fast bacilli. Despite treatment with meropenem and clindamycin, the infiltrating shadow worsened. Since bronchial lavage and sputum culture were positive for M. fortuitum, these drugs were replaced with minocycline and imipenem. Thereafter, the shadow on the chest radiograph improved. After discharge, outpatient treatment with clarithromycin and levofloxacin was continued. After 4 months, the residual tumor shadow in the right upper lobe gradually grew. When a CT-guided transcutaneous needle lung biopsy was undertaken, malignant cells were found. Right upper lobectomy was performed. Pathological examination of the lesion demonstrated small-cell lung cancer. If a lesion does not change after nontuberculous mycobacteria treatment, the physician should consider other lesions such as lung cancer.     

胸膜结核球的诊断和治疗(附31例临床分析)

目的 探讨胸膜结核球临床及X线特点?方法 分析 1.970～ 1.998年收治的 3.1例胸膜结核球?结果 1.19例既往有明确的渗出性胸腔积液史 ( 61.3 % ) ,经治疗胸水吸收 ,数月至数年后发现球形病灶?2.24例正侧位胸片有不同程度的胸膜增厚?钙化及肋膈角改变 ( 77.4 % )? 3 本组误诊为肺癌?胸膜间皮细胞瘤及错构瘤等占 4.52 % ( 1.4 / 3.1 )?结论 胸膜结核球结合完整的病史 ;依靠切线位片?CT及胸部透视即可诊断?经积极的抗结核治疗可避免手术?     

右侧胸膜平滑肌瘤合并肺炎1例

目的:平滑肌瘤是一种罕见的起源于平滑肌纤维的良性肿瘤。平滑肌瘤在呼吸道是罕见的，在胸膜更是少见。这是我们决定报道这个右侧胸膜平滑肌瘤合并肺炎病例的主要原因。病例报告：我们报告一例50岁男性患者，以“右侧胸痛、气短1天”之主诉入院，行胸部X线及薄层CT(HRCT, high-resolution computed tomography)提示右侧胸腔积液伴右下肺炎症，行相关化验、支气管镜检查及B超引导下胸腔穿刺术均未能明确诊断，在超声引导下行右侧胸膜穿刺活检术，结合组织病理学和免疫组织化学检查考虑为右侧胸膜平滑肌瘤。经对症治疗肺炎症状渐缓解，必要时行手术治疗。结论:在考虑胸膜肿瘤的鉴别诊断时，原发性胸膜平滑肌瘤仍有可能。该病的诊断主要依靠组织病理学检查。     

Successful treatment of non-small cell lung cancer by gefitinib in an elderly patient with poor performance status

A 91-year-old woman was admitted to our hospital with dyspnea. A chest radiograph and chest CT films revealed a large amount of pleural effusion in the right side pleural cavity. After serial thoracentesis, chest CT films showed a mass shadow in the right S(6). Adenocarcinoma cells were found in the pleural effusion, leading to a diagnosis of non-small cell lung cancer (stage IIIB). After administration of gefitinib, the mass shadow and pleural effusion reduced and her performance status improved. Gefitinib may be a well-tolerated therapeutic strategy in elderly and poor performance status patients with advanced non-small cell lung cancer.     

可弯曲内科胸腔镜检查在肺癌分期中的应用价值探讨

目的探讨可弯曲内科胸腔镜检查在肺癌分期中的临床应用价值。方法采用Olympus LTF-240型可弯曲内科电子胸腔镜,对病理已确诊的肺癌25例行内科胸腔镜检查。25例包括腺癌14例、鳞癌8例、小细胞肺癌3例,根据胸部CT结果分为：胸腔积液组15例,无胸腔积液组（cT未见胸腔积液但可见胸膜病变）10例。结果胸腔积液组可见胸膜病变10例,包括结节9例、扁平隆起1例,经内科胸腔镜检查证实为胸膜转移7例,排除胸膜转移8例;无胸腔积液组可见胸膜病变9例,包括结节7例、扁平隆起、自斑1例、胸膜瘢痕样增厚1例,经胸腔镜检查证实为胸膜转移7例,排除胸膜转移3例。经内科胸腔镜排除胸膜转移的11例中6例转外科手术治疗,术中均未见胸膜转移。25例胸腔镜检查均未见严重并发症。结论可弯曲内科胸腔镜检查能在微创代价下提高肺癌分期的准确率。建议对于胸部CT可见胸水或胸膜病变的肺癌确诊病例,在分期诊断中积极行内科胸腔镜检查。     

A small cell lung cancer shadow resembling beads on chest radiographs]

We present a case of small cell lung cancer whose shadow resembles bead son chest radiographs. An 81-year-old woman who had been receiving treatment from her doctor for pulmonary emphysema and chronic respiratory failure consulted our department because a small nodular shadow had been detected radiographically in the right lower lung field. The bead-like shadows in the radiographs and tomograms extended from the periphery of the right lower lobe to the pulmonary hilum. This case of small cell lung cancer appeared in chest radiographs to have an unusual shape.     

Assessment of asbestos-induced pleural disease by computed tomography--correlation with chest radiograph and lung function

We compared computed tomography (CT) scanning with chest radiography in the assessment of asbestos-induced pleural disease (AIPD) in 20 patients (17 men and 3 women, mean age 55 years, range 43-74 years). Involved pleura was scored on plain chest radiographs according to the International Labour Office (ILO) method of evaluating AIPD. A CT score was calculated from the measurement, using a digital length probe, of the circumference of the chest wall involved by pleural disease in each slice. The maximum width of pleural disease was taken into account in a way analogous to the ILO method for the chest radiograph. The CT score correlated with the chest radiograph score (r = +0.82, P less than 0.0006). CT demonstrated discrete plaques in 95% of patients but these were identified only in 59% patients on the radiograph. Diffuse pleural thickening was evident on the CT scan in all patients and in 70% on the radiograph. There was more inter-reader agreement about the type of pleural disease on the CT scans than on the chest radiographs. CT and chest radiograph scores inversely correlated with all lung function measurements except KCO. We conclude that increasingly extensive pleural disease is associated with increasingly severe impairment of lung function. CT scanning demonstrates the type of AIPD better than plain chest radiography.     

Pulmonary suppuration due to a mixed infection of anaerobic bacterium and Actinomyces]

We report a case of pulmonary suppuration due to a mixed infection of anaerobic bacterium and Actimomyces. A 49-year-old man was admitted to our hospital because of hemoptysis on March 30, 1999. A chest X-ray film showed a localized shadow in the right middle lobe, and a tumor shadow was recognized on chest CT. The anaerobic bacterium were isolated from specimens collected bronchofiberscopically. A diagnosis of pulmonary suppuration due to anaerobic bacterium was made, and treatment with sulbactam/ampicillin, followed by imipenem/cilastatin, was initiated. Although his clinical symptoms and laboratory data improved rapidly following this treatment, the abnormal finding on the chest radiographs remained, with only slight improvement. Accordingly, surgical resection of part of the right middle lobe was performed on June 29 using a video-associated thoracic surgery technique. Actinomycosis was recognized by pathological examination of the resected lesion. A revised diagnosis of pulmonary suppuration due to a mixed infection of anaerobic bacterium and Actinomyces was made. Anaerobic bacterium in the oral cavity are recognized as significant pathogens in pulmonary suppuration. In the present case, we considered anaerobic bacterium and Actinomyces aspirated from the oral cavity into the lung to have caused the pulmonary suppuration.     

Autopsy case of diffuse pleural thickening presenting respiratory impairment and benign asbestos pleurisy]

A 51-year-old man presented with back pain in 1997. He had a 30-year-history of occupational asbestos exposure. His chest CT showed bilateral pleural thickening and pleural effusion. The pleural effusion of the right thorax exhibited both elevated level of adenosine deaminase and increased numbers of lymphocytes. Antituberculous chemotherapy had no effect on the exudates. Progressive bilateral pleural thickening were found on chest CT, and pulmonary function tests showed severe restrictive ventilatory impairments since 1998. Thoracoscopic pleural biopsy was conducted in 2001 to exclude pleural malignant mesothelioma. No malignancy was found in pleural samples. After 3-year observation and excluding other causes, he was given a diagnosis of benign asbestos pleurisy. In 2005, fibrotic changes were found in both lower lung fields in chest CT. He suffered from respiratory failure with carbon dioxide retention, and died in 2006. The autopsy disclosed asbestos-related lung diseases. We suspected that diffuse pleural thickening could be a major cause of fatal respiratory impairment in this case.