胸膜孤立性纤维瘤误诊原因分析

目的 分析胸膜孤立性纤维瘤(solitary fibrous tumor of the pleura,SFTP)的误诊原因,提高其诊断率. 方法 收集并分析自2000年6月至2008年9月广州医学院第一附属医院胸外科收治的21例SFTP的临床资料及随访结果. 结果 21例中男9例,女12例,年龄33～76岁,平均(52.5±14.3)岁,病程7 d至8年,病程中位数为4个月.术前诊断胸膜间皮瘤7例,神经源性肿瘤6例,肺癌4例,SFTP 2例,肺门淋巴结结核1例,炎性肉芽肿1例.术前只有2例诊断正确.21例均行肿瘤根治性切除,术后标本病理学检查及免疫组织化学分析结果均为良性SFTP.随访3个月至8年,中位随访期为43个月,失访2例,余19例均未发现复发及转移. 结论 SFTP临床症状无特异,易误诊为肺癌及胸膜间皮瘤等常见肿瘤;支气管镜及经皮肺穿刺活检术诊断率不高.对于胸腔内肿块而无淋巴结肿大的患者,有条件时应进行cT扫描三维重建,注意肿块是否具有"蒂"征,同时可行胸部x线透视观察肿块在改变体位时的活动情况.

The analysis on the misdiagnosis of solitary fibrous tumor of the pleura

Objective To report the characteristics of solitary fibrous tumor of the pleura(SFTP),and to analyze the factors associated with the misdiagnosis of this disease. Methods A retrospective review of the clinical records of 21 cases of SFTP in our hospital from June 2000 to September 2008 was conducted.The follow-up data were also reviewed. Results The preoperative diagnosis was pleural mesothelioma in 7 cases,neurogenic tumor in 6,lung cancer in 4,SFTP in 2,hilar lymph node tuberculosis in 1 and inflammatory granuloma in 1 case.All the eases underwent radical resection.and postoperative pathology and immunohistochemical study were performed,and the diagnosis of benign solitary fibrous tumor of the pleura was confirmed.Follow-up periods ranged from 3 months to 8 years(median,43 months).Two cases were lost,and the remaining 19 cases reported no recurrence or metastasis. Conclusion The recognition of the clinical characteristics of pleural solitary fibrous tumor is essential for improving the diagnosis of this uncommon disease.