肺良性转移性平滑肌瘤一例诊疗体会及文献复习  

Pulmonary Benign Metastasizing Leiomyoma: A Case Report and Literature Review

作　　者：陈石[1,2] 刘锐敏[3] 张静莹[2] 黄茂[1] 

机构地区：[1]南京医科大学第一附属医院呼吸科,江苏南京210029 [2]江苏省中医院呼吸科,江苏南京210029 [3]南京大学医学院附属鼓楼医院内科江苏南京210008

出　　处：《中国呼吸与危重监护杂志》2013年第5期472-476,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的提高对肺良性转移性平滑肌瘤的认识。方法回顾分析南京医科大学第一附属医院2012年10月诊断的1例肺良性转移性平滑肌瘤,并复习相关文献。结果患者为32岁女性,行子宫肌瘤切除术1个月后出现活动后胸闷、气喘,乏力明显,胸部CT示两肺弥漫分布粟粒状影,血肿瘤标记物正常。予抗结核治疗4周后复查胸部CT无明显变化,遂予胸腔镜肺活检。HE染色显示肿瘤细胞具有平滑肌细胞的分化特征;免疫组化提示肿瘤细胞增殖指数较低,不支持肺部恶性肿瘤;Desmin、SMA平滑肌特异性标志物强阳性;雌激素受体、孕激素受体表达强阳性,符合肺良性转移性平滑肌瘤的特点。确诊后即给予口服三苯氧胺(tamoxifen)抗雌激素治疗3个月。目前患者无疾病继续发展及进一步远处转移的放射学证据,仍在继续随访。结论良性转移性平滑肌瘤是一种会发生在任何年龄组的罕见疾病,最常见于晚育女性,所有患者均有子宫的平滑肌瘤历史和/或行子宫肌瘤切除术,并且常常合并有远离子宫部位的转移,其中以肺部最多见。Objective To improve the knowledge of pulmonary benign metastasizing leiomyoma. Methods A case of pulmonary benign metastasizing leiomyoma diagnosed in the First Affiliated Hospital of Nanjing Medical University was analyzed. Results A 32-year-old woman suffered from chest stuffiness, heavy pant and weakness after myomectomy in a month. Chest CT showed miliary shadow was diffused in both sides of her lungs,but serum tumor marker was normal. When the chest CT result did not change significantly ＇after four-week＇ s anti-tuberculosis treatment,the patient accepted lung biopsy by thoracoscopic surgery. HE staining showed that the tumor cells had characteristics of smooth muscle cell differentiation. Immunohistochemical staining showed a low proliferation index of tumor cells, which did not indicate the existence of pulmonary malignant tumor. Smooth muscle actin （SMA） and desmin as the specific markers of smooth muscle,estrogen receptor （ER） and progesterone receptor （PR） were all strongly positive,which was the characteristic of pulmonary benign metastasizing leiomyoma. The patient was given the anti-estrogen tamoxifen for 3 months. Without radiological evidence of disease development and further distant metastasis, the patient had been followed up. Conclusions Pulmonary benign metastasizing leiomyoma is a rare disease which can occur in any age group, particularly prevalent among late childbirth women. All patients have uterine leiomyoma history and/or myomectomy operation, often associated with uterine metastasis, which commonly occurs in lung.

关 键 词：良性转移性平滑肌瘤 子宫肌瘤切除术 肺转移 肺活检 

分 类 号：R734.2[医药卫生—肿瘤]