肺癌肉瘤与肺母细胞瘤的临床分析及文献复习

目的 探讨肺癌肉瘤与肺母细胞瘤的临床特点、诊断、治疗方法、以提高其诊断率。方法 回顾性地总结自１９７９年１月￣１９９８年１１月收住的肺癌肉瘤１５例，肺母细胞瘤２例，并结合献对其组织发生、临床表现、诊断及治疗方法进行分析。结果 肺癌肉瘤及肺母细胞瘤均为肺内罕见的恶性肿瘤，镜下均可见上皮及间质两种成分，但又有其不同之处，手术前很难确诊。肺癌肉瘤主要症状为咳嗽、咳痰，血丝痰等。Ｘ线示以周围型居多，病灶

The clinical analysis and review of literature of pulmonary carcinosarcoma and blastoma

OBJECTIVE: To explore the clinical characteristics, diagnosis, treatment of pulmonary carcinosarcoma and blastoma. METHODS: Summarizing retrospectively 15 cases of pulmonary carcinosarcoma and 2 cases of pulmonary blastoma from January 1979 to November 1998, and reviewing literature to analyse their histologic, clinical feature, diagnosis and treatment. RESULTS: Pulmonary carcinosarcoma and blastoma both were found to be rare malignant tumors, and both epithelial and mesenchymal elements can be seen under the microscopy with different characteristic features. It was hard to be diagnosed before operation. The main symptoms of pulmonary carcinosarcoma were cough, expectoration, sometimes bloody phlegm. X-ray showed that peripheral type were most common, and 2-5 cm in size, well-distributed in density, some showed central or eccentric cavities whose wall was irregular. The margin of the focuses were clear, leafy, the distensive lymph nodes of hilum or mediastium could also be seen. Bronchoscopic examination revealed the bronchial cavity was obstructed by mass or became stricted. Local biopsy can found squamous, adenocarcinoma or large cell carcinoma, respectively. Malignant cell can also be found in sputum. So it was easy to be confused with lung cancer. 14 cases of the carcinosarcoma were treated surgically and diagnosed, 1 case was diagnosed by lymph node biopsy. The symptoms of pulmonary blastoma were fever and hemoptysis. X-ray or CT scan showed an isolated mass in the lung, with uneven density. Malignant cells in pleural effusion were found in one case and can not be diagnosed definetely but by pulmonary puncture. The another case was diagnosed by surgical operation. 15 cases of this group were followed up, in which 4 cases are still alive (including 1 case of pulmonary blastoma), the 1-year survival of carcinosarcoma is 30% (3/10), 2-year survival 20% (2/10), in which 1 case survived more than 6 years. Another pulmonary blastoma case only survived 3 months. CONCLUSIONS: These 2 kinds of malignant tumor are often easy to be misdiagnosed, and prognosis is very poor. Surgical resection is the main method of diagnosis and treatment.