肺淋巴管肌瘤病的临床及病理特点

目的 提高对肺淋巴管肌瘤病(lymphangioleiomyomatosis,LAM)的临床及病理诊断和认识水平.方法 回顾分析复旦大学附属中山医院确诊为肺LAM的病例15例,并复习1993-2008年国内文献的73例报道,分析该病的临床及病理特点.其中1例患者死后行尸体解剖,对其全身各脏器进行病理组织学观察.结果 88例患者均为女性,平均发病年龄(37±9)岁,常见临床表现依次为呼吸困难83例(94%)、咯血48例(54%)、气胸41例(47%)、乳糜胸28例(32%).其中35例患者行肺功能检查,32例存在弥散功能障碍,25例表现为阻寨性通气功能障碍,10例表现为混合性通气功能障碍.胸部高分辨率CT检查显示双肺为典型的弥漫性薄壁囊状阴影.病理检查结果显示肺组织旱弥漫性囊状改变,增生的LAM细胞沿细支气管壁、肺泡壁、淋巴管肇和血管壁周围分布,形成结节状.1例尸解病理检查结果显示肺脏、肾脏、淋巴结及软组织等多器官受累.42例行腹部B超及影像学检查,其中23例伴发肺外LAM.结论 LAM常累及全身多个系统,但肺是最主要的受累器官.育龄期妇女出现进行性呼吸困难、气胸、乳糜胸及高分辨CT表现为弥漫性小囊状改变时,应考虑到LAM的可能.确诊需依赖肺组织活检病理检查结果,并应常规进行腹部及盆腔影像学检查,以了解患者是否合并肺外LAM.

Clinicopathologic analysis of pulmonary lymphangioleiomyomatosis

Objective To improve the understanding and diagnosis of pulmonary lymphangioleiomyomatosis (LAM). Methods Fifteen cases of LAM of our hospital were presented and 73 cases reported in domestic literature from 1993 to 2008 were reviewed. By means of histological and immunohistochemical(IHC)studies, the clinical and pathological features of LAM were analyzed. Results All the 88 cases were female, with an average age of onset at (37±9) years. The main clinical menifestations included dyspnea (83/88, 94%), hemoptysis (48/88, 54%), pneumothorax (41/88, 47%), and chylothorax (28/88, 32%). High resolution computerized tomography(HRCT) showed thin-walled air-filled cysts throughout both lungs. Pathological features showed cystic changes in the lung, and abnormal smooth muscle cells (LAM cells) lined the airways, bronchioles, lymphatics and blood vessels leading to airflow obstruction and replacement of the lung parenchyma by cysts. In the autopsy case, extrapulmonary organs (eg, kidney, lymph nodes and soft tissues) were also involved. Abnormal manifestations in abdomen, including renal mass, retroperitoneal mass and retroperitoneal lymphadenopathy, were detected in 23 cases. Conclusions LAM is a muhisystem disease. Chest HRCT had confirmative value for diagnosis of LAM. In practice, chest HRCT, as well as other routine abdominal and pelvic imaging examinations, should be performed for child-bearing-age women with progressive dyspnea, hemoptysis, or spontaneous pneumothorax.