肺炎性假瘤(附17例报告)

本文报告17例肺炎性假瘤的临床和病理表现,并着重对第1型病理表现做了讨论。肺炎性假瘤是发生在肺实质内的假性肿瘤,常误诊为肺内真性肿瘤或其他病变。作者检查本科6年来肺部疾患切除标本,发现肺炎性假瘤11例及外院会诊6例,报告如下。     

炎性假瘤合并肺癌：附6例报告

本组炎性假瘤合并肺癌６例，占同期炎性假瘤的７．６％（６／７９）。近年发病率有上升趋势，应引起重视。其可分为三种形式：（１）假瘤癌变；（２）两瘤并存；（３）癌件假瘤。其临床特点为以发热为首发症状，继之持续性咳嗽伴痰中带血，而胸片见瘤体较大而无淋巴结转移征象。合并肺癌的炎性假瘤主要为假乳头瘤型和组织细胞型。肺癌多为鳞癌，亦可有腺癌及未分化癌。手术标本表现假瘤瘤体极大，而癌灶极小可造成误诊或漏诊。详尽的术前检查如痰细胞学检查，支气管镜检查及经皮肺针吸活检对确立最后正确诊断帮助较大。因假瘤部分巨大，合并肺癌分期相对较早，其预后较单纯肺癌为好。     

肺炎性假瘤12例分析

肺炎性假瘤是一种少见的肺炎性增生性瘤样病变,临床易误诊。我院自1974年到1988年收治12例,均经手术切除及病理证实,报道如下: 临床资料一、一般资料 12例中男8例,女4例,占同期拟诊肺癌而手术者170例的7.1％。     

肺炎性假瘤：（附18例报告）

报告18例肺炎性假瘤,其中男11例,女7例。平均年龄46岁。所有病例均经肺切除手术,炎性假瘤直径1.2～13cm,占因肺肿瘤而手术病例的8.6％。16例于术前进行过支气管纤维镜检查,3例有段支气管狭窄,1例外压性支气管闭锁,2例病变突入支气管内。病理报告,纤维组织细胞型11例(64.7％),浆细胞型5例(29.5％),假性淋巴瘤型1例(5.8％)。     

大肠息肉与大肠癌发生临床病理观察

我科自1981年12月至1986年5月,应用纤维结肠镜,检查患者398例,检出大肠息肉97例,其中脉瘤性息肉77例(管状腺瘤71例、绒毛状腺瘤6例),单发44例、多发33例,其他型息肉20例。检出大肠癌33例,其中息肉癌变5例,单发息肉癌变l例,多发息肉癌变4例;息肉与癌共存12例,癌与多发息     

肺炎性假瘤诊断及外科治疗71例

目的：总结肺炎性假瘤诊断及外科治疗体会，方法：对1970年12月－2000年12月71例肺炎性假瘤的临床资料进行回顾性分析。女49例，男22例，年龄23－72岁，平均45．2岁，肺叶切除44例，楔形切除18例，肺段切除8例，探查活检1例，术中冰冻病理切片13例，肺炎性假瘤11例，错构瘤1例，可疑腺癌1例，术后病理考虑恶性变5例。结果：5例恶性变者，3例已生存5年，2例术后5年内死于复发，转移，余66例预后良好，结论：术前诊断较困难，治疗以手术切除为主，术中冰冻病理切片检查对决定术式有帮助。     

26例肺炎性假瘤临床分析

目的通过分析肺炎性假瘤的诊断及鉴别诊断,总结其临床特点,提高临床诊断率。方法回顾性分析近7年来收治的肺炎性假瘤患者26例。结果术前初步诊断为肺炎性假瘤7例,肺癌12例,肺结核3例,畸胎瘤1例,神经鞘膜瘤2例,转移瘤1例,误诊率73.1%。结论提高对肺炎性假瘤发病及临床特点的认识能够帮助降低误诊率。     

肺炎性假瘤的组织化学及免疫组织化学观察

肺炎性假瘤为肺实质局限性增生性炎症,临床及X线表现酷似真性肿瘤,极易误诊。本文13例炎性假瘤中,X线检查误诊为肺癌者10例,误诊为肉瘤1例,结核球2例;纤支镜活检误诊为小圆细胞癌者1例;病理快速冰冻切片下误诊为肺癌者1例。     

肺炎性假瘤5例报告

肺炎性假瘤近年来有增多趋势,依靠临床检查和X线表现诊断容易误诊。自1981年以来,我们对手术后切除的肺标本行病理学检查,最后获得确诊的肺炎性假瘤有5例,因该病术前诊断困难,现报告如下,以引起临床医生的注意。     

食管癌伴肺部肿块16例分析

目的探讨食管癌同时伴有肺部肿块的处理方法.方法分析16例食管癌同时伴有肺部肿块,经术中或术后病理检查证实为非肿瘤转移患者的临床资料.结果肺隔离症2例,肺结核瘤3例,双肺炎性假瘤2例,双原癌9例.行肺叶切除10例,肺楔形切除2例,病灶切除或活检4例.结论食管癌同时伴有肺部肿块并非都是转移,可能存在多种可能性,应在获得病理诊断的情况下,采取相应的治疗方法.     

肺癌薄层CT增强扫描与病理对照的初步研究

目的 定量对比分析周围型肺癌和肺炎性假瘤、肺结核球的CT强化程度和病灶内血管的关系,探讨肺癌病灶内血管结构对其CT强化水平的影响。方法 以薄层CT扫描研究肺癌、肺炎性假瘤和肺结核球强化后的平均CT增值;用电脑图像分析仪计量病灶内小血管数（内径0.02-0.1mm)、较大血管数（内径＞0.1mm)及其血管床总面积,以统计学处理其CT增值与血管计数、血管床面积的相关性。结果 （1）增强扫描后,病灶的平均CT增值在肺癌、肺炎性假瘤和肺结核球间差异有显著性（P＜0．05）;（2）小血管数、较大血管数及血管床面积在三种病变间差异有显著性（P＜0．05）;（3）肺癌CT增值与小血管数和较大血管数具有相关性,且与小血管数相关性较大;（4）三种病变CT增值与较大血管数、血管总数及血管床面积具有相关性。结论 （1）CT强化程度的分组,对肺癌与肺炎性假瘤、肺结核球的鉴别诊断有一定意义;（2）肺癌与肺炎性假瘤、肺结核球的平均CT增值与病灶内的血管数和血管床面积呈正相关;（3）肺癌病灶CT增值可反映癌灶内血管性状及其血供情况。     

Transthoracic fine-needle aspiration biopsy of pulmonary spindle cell and mesenchymal lesions: a study of 61 cases

BACKGROUND: Spindle cell and mesenchymal lesions of the lung encompass a wide variety of benign and malignant conditions. However, to the authors' knowledge, because of their rarity, few reports concerning their cytologic findings are available in the literature. The current review emphasizes the cytomorphologic features, differential diagnosis, and potential pitfalls associated with these lesions. METHODS: Seven hundred seventy-nine percutaneous lung fine-needle aspiration (FNA) specimens were retrieved from the authors' cytopathology files over a period of 5 years. Sixty-one cases (7.8%) in which a spindle cell component was the dominant or key feature were identified. The authors reviewed the cytologic smears, immunocytochemical studies, and corresponding surgical material and clinical information. RESULTS: Of these 61 aspirates, 33 (54%) were reactive processes (31 granulomas, 1 organizing pneumonia, and 1 inflammatory pseudotumor). Five cases (0.8%) were benign neoplasms (2 hamartomas, 2 solitary fibrous tumors, and 1 schwannoma). Twenty-three cases (38%) were malignant neoplasms (8 cases were primary tumors [including 5 carcinomas with spindle cell or sarcomatoid features, 1 spindle cell carcinoid tumor, 1 leiomyosarcoma, and 1 synovial sarcoma] and 15 cases were secondary tumors [including 9 melanomas, 2 leiomyosarcomas, 1 malignant fibrous histiocytoma, 1 meningioma, 1 sarcomatoid renal cell carcinoma, and 1 uterine malignant mixed müllerian tumor]). A specific diagnosis was rendered in 52 cases (85%). No false-positive cases were encountered but there was one false-negative case. One patient who was diagnosed with granulomatous inflammation on FNA was found to have nonsmall cell lung carcinoma on subsequent transbronchial biopsy. No malignant cells were identified in the smears on review. The FNA from the organizing pneumonia was interpreted as a solitary fibrous tumor whereas the inflammatory pseudotumor was diagnosed as granulomatous inflammation. The FNA from one pulmonary hamartoma initially was considered to be nondiagnostic. One solitary fibrous tumor and the schwannoma were diagnosed as smooth muscle tumor and spindle cell tumor, not otherwise specified, respectively. Among the malignant tumors, the primary synovial sarcoma and one of the metastatic malignant melanomas initially were interpreted as primitive neuroectodermal tumor/Ewing sarcoma and poorly differentiated carcinoma, respectively. CONCLUSIONS: Spindle cell lesions of the lung rarely are encountered on transthoracic lung FNA and are comprised of a wide variety of benign and malignant entities. By correlating clinical and radiologic data, cytologic findings, and ancillary studies, a high diagnostic accuracy rate can be achieved with FNA.     

CT增强薄层扫描异形血管强化征对小肺癌诊断的价值

目的：探讨ＣＴ增强薄层扫描图像上显示的异形血管强化征对小肺癌诊断和鉴别诊断的临床价值。方法：用ＣＴ增强薄层扫描和常规ＣＴ增强扫描对比研究３７例直径＜３ｃｍ的小肺癌,并同期研究１８例需鉴别的肺炎性假瘤和肺结核球作对照,分析这３种病变的ＣＴ增强薄层扫描征象特点。结果：①ＣＴ增强薄层扫描能清晰显示小肺癌病灶内肿瘤血管的特征性表现一异形血管强化征,而常规ＣＴ扫描难以显示该征象;②肺炎性假瘤和肺结核球病灶内一般不出现该种病理血管征象。结论：异形血管强化征对小肺癌的诊断和鉴别诊断具有特殊意义。     

肺内孤立结节病灶24例临床分析

目的：分析24例肺内孤立性肺病灶（ SPN）的发病特点、影像学表现、病理诊断、治疗及随访结果。方法：回顾性分析2007年7月-2010年12月经手术治疗的24例肺内孤立结节病灶的临床资料。结果：24例中恶性11 例（45. 8％）：肺腺癌7 例,鳞癌2 例,小细胞癌1 例,肺转移癌1 例。肺良性病变13 例（54. 2％）：肺结核球4 例,错构瘤3 例,硬化性血管瘤3 例,炎性假瘤、神经纤维瘤、肺霉菌病各1 例。结论：肺内孤立性肺病灶,病因多样,恶性约占50％,鉴别诊断上仍有一定困难。治疗上应采取积极的态度,及早手术切除,术中病理检查,恶性者以肺叶切除为主,良性者则应行局部切除包括肺楔形或病灶剔除术。     

拟诊肺癌而行全肺切除的良性病变

[目的]探讨肺内良性病变诊为肺癌而行全肺切除的原因。[方法]回顾性分析1998年8月-2008年8月因拟诊肺癌而行全肺切除的良性疾病患者14例的临床资料。[结果]14例患者术前均拟诊为肺癌,行左全肺切除术11例,右全肺切除3例。术后病理为肺结核8例（3例伴淋巴结结核）,肺脓肿2例,炎性假瘤2例,炎性肉芽肿1例,错构瘤1例。术后3例出现并发症（肺动脉栓塞2例,ARDS1例）,并发症发生率为21．4％,无围手术期死亡发生。[结论]肺结核、炎性肉芽肿、肺脓肿、炎性假瘤、错构瘤是最易诊为肺癌而行全肺切除的良性疾病,应严格把握肺内良性病变行全肺切除的手术指征。     

双肺多发炎性假瘤1例

炎性假瘤是一种肺部少见的良性肿瘤,其发病率仅占肺部肿瘤的0.7%,而双肺多发炎性假瘤更为罕见,在临床工作中常被误诊为转移瘤或播散性肺结核,国内外文献报道尚少。本文介绍临床工作中遇到的罕见双肺多发炎性假瘤1例,并初步探讨其诊断和治疗。     

Clinical and Histopathologic Correlates and Management Strategies for Inflammatory Myofibroblastic tumor of the lung. A case series and review of the literature

Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm that may arise in soft tissues of nearly every organ. Although IMTs are the most common lung tumors in pediatric populations, these tumors are extremely rare in adults, constituting less than 1% of adult lung tumors. IMTs are characterized by proliferating spindle cells with variable inflammatory component. The biological behavior of lung IMTs in adults is highly unpredictable, which confounds diagnosis and treatment. We retrospectively investigated patients with pulmonary lesions and the histopathologic diagnosis of inflammatory myofibroblastic tumor or its synonymous names (Plasma Cell Granuloma, xanthogranuloma, inflammatory pseudotumor, fibroxanthoma, and fibrous histiocytoma) at the MD Anderson Cancer Institute in the period between August 2000 and August 2016. We describe 7 adult cases of IMT of the lung that were diagnosed at MD Anderson Cancer Center. These cases highlight the tumor’s variability in terms of clinical presentation, histopathology, and biologic behavior, and underscore the challenges in the management of these rare lung neoplasms.