肺良性转移性平滑肌瘤合并原发性肺腺癌1例报道并文献复习  

Pulmonary benign metastatic leiomyoma complicated with primary lung adenocarcinoma:report of a case and review of the literature

作　　者：梁云 刘颖[2] 谢宁[1] 张蔚 费秀渠 刘曙亮 Liang Yun;Liu Ying;Xie Ning;Zhang Wei;Fei Xiuqu;Liu Shuliang(Department of Thoracic Surgery,Yantai City Yantaishan Hospital,Yantai 264000,China;Department of Pathology,Yantai City Yantaishan Hospital,Yantai 264000,China)

机构地区：[1]滨州医学院附属烟台市烟台山医院胸外科,烟台264000 [2]滨州医学院附属烟台市烟台山医院病理科,烟台264000

出　　处：《中华解剖与临床杂志》2023年第12期806-811,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨肺良性转移性平滑肌瘤(PBML)合并原发性肺腺癌的临床、影像及病理学特征,提高临床医生对该病的认识。方法回顾性分析2022年5月滨州医学院附属烟台市烟台山医院收治的1例PBML合并肺腺癌患者的临床特征、检查结果、诊疗经过,同时进行相关文献的复习。在中国知网、万方数据、中华医学期刊全文数据库、Web of Science、SpringerLink等数据库中,以“肺良性转移性平滑肌瘤AND肺腺癌”,以及“pulmonary benign metastatic leiomyoma AND lung adenocarcinoma”或“PBML AND lung adenocarcinoma”为关键词进行检索,检索到文献报道PBML合并肺腺癌患者共3篇3例。结合本例资料,分析PBML合并肺腺癌患者的临床、影像及病理学特征,及其可能的发病机制和有效的治疗方法。结果本例患者为44岁女性,有2次子宫肌瘤手术史。胸部CT提示双肺多发大小不等实性结节,右肺中叶较大结节直径1.5 cm,右肺上叶2个磨玻璃结节直径分别为1.5 cm、0.7 cm;术前能谱CT提示肺内多发病灶的同源性。行胸腔镜右肺中叶楔形切除+右肺上叶楔形切除+淋巴结采样术,结合既往史和病理学检查证实为PBML合并原发性肺腺癌(pT1bN0M0,IA2)。结合文献报道的3例,共4例PBML伴原发性肺癌患者,均为女性并有子宫平滑肌瘤手术史,年龄为38~51(45.8±5.2)岁,均行手术治疗并经术后病理检查得以确诊,均获临床治愈。结论PBML合并原发性肺腺癌临床罕见,缺乏临床及影像学特征性表现,需结合病史、组织形态和免疫组织化学染色结果进行诊断。PBML发病机制尚不清楚,可能由手术或者外力诱发致使良性平滑肌瘤细胞经静脉系统转移至肺部;手术为其主要治疗方法,内分泌治疗可能有效。Objective This study aimed to investigate the clinical,imaging,and pathological features of pulmonary benign metastasizing leiomyoma(PBML),as well as to improve clinicians'understanding.Methods The clinical characteristics,examination results,diagnosis,and treatment of a patient with PBML combined with lung adenocarcinoma admitted to Yantai City Yantaishan Hospital affiliated to Binzhou Medical University in May 2022 were analyzed retrospectively,and the relevant literature was reviewed."肺良性转移性平滑肌瘤AND肺腺癌",以及"pulmonary benign metastatic leiomyoma AND lung adenocarcinoma"或"PBML AND lung adenocarcinoma"were used as study to explore the possible pathogenesis and effective treatment.Results The patient was a 44-year-old woman with a history of two-time hysteromyoma operations.Physical examination of chest CT showed multiple solid nodules of different sizes in both lungs.The larger one was located in the middle lobe of the right lung with a diameter of 1.5 cm.The upper lobe of the right lung had two ground glass nodules with diameters of 1.5 and 0.7 cm,respectively.Spectral CT could effectively identify the homology of multiple lung lesions before operation,which was helpful in creating the operation plan.Thoracoscopy was performed under general anesthesia for wedge resection of the right middle and upper lobes in addition to lymph node sampling.Combined with past history and pathological examination,the patient was confirmed to have PBML complicated with primary lung adenocarcinoma(pT1bN0M0,IA2).On the basis of the data of three previously reported PBML patients with primary lung cancer,a total of four patients were female and had a surgical history of uterine leiomyoma,aged 38 to 51(45.8±5.2)years old,and were confirmed pathologically after surgical treatment.Conclusion PBML complicated with primary lung adenocarcinoma is rare and which lacks obvious clinical symptoms and imaging manifestations.Diagnosis should be made based on medical history,morphology,and immunohistochemistry metho

关 键 词：肺肿瘤 平滑肌瘤 肺良性转移性平滑肌瘤 肺腺癌 

分 类 号：R734.2[医药卫生—肿瘤]