硬化性肺泡细胞瘤的临床特征分析  

Analysis of clinical characteristics of pulmonary sclerosing pneumocytoma

作　　者：宋敏[1] 胡依粉 苗玉昴 智晓 刘艳[4] Song Min;Hu Yifen;Miao Yumao;Zhi Xiao;Liu Yan(Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Jining Medical University,Jining 272029,China;Department of Respiratory Endoscopy,Affiliated Hospital of Jining Medical University,Jining 272029,China;Department of Pathology,Affiliated Hospital of Jining Medical University,Jining 272029,China;Health Management Center,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院呼吸与危重症医学科,济宁272029 [2]济宁医学院附属医院呼吸内镜室,济宁272029 [3]济宁医学院附属医院病理科,济宁272029 [4]济宁医学院附属医院健康管理中心,济宁272029

出　　处：《国际呼吸杂志》2024年第5期568-575,共8页International Journal of Respiration

摘　　要：目的分析硬化性肺泡细胞瘤(PSP)的临床特征。方法本研究为观察性研究,采用非随机抽样法选取2010年1月至2022年8月于济宁医学院附属医院经病理确诊的13例PSP患者。收集所有患者的临床资料,包括基本资料、临床表现、实验室检查结果、影像学表现、诊断方法、病理学特征、治疗与随访等。采用门诊复查、电话等方式对患者进行随访,随访时间截至2023年11月。结果13例PSP患者均为女性,中位年龄58岁,年龄范围30~72岁。3例患者无任何呼吸系统症状,通过健康查体发现;咳嗽咳痰8例,其中1例偶有痰中带血;干咳1例;左下季肋处隐痛1例。实验室检查结果均正常。胸部CT显示8例为单发结节,4例合并双肺多发结节,1例为多发团片状软组织密度影;12例外观呈圆形或类圆形,其中10例边缘光滑、边界清晰,1例边缘可见毛刺影,1例周围可见点片状磨玻璃密度影;增强CT扫描显示,轻度强化2例,中度强化2例,高度强化3例,不均匀强化6例;血管贴边征阳性5例,周围支气管绕行1例,钙化2例。1例通过超声引导下经支气管针吸活检确诊,2例通过CT引导下经皮穿刺肺活检术确诊,其余10例均行手术确诊,其中6例在术中经快速病理检查确诊。7例行常规病理学检查联合免疫组织化学确诊。病理学特征主要表现为类似肺泡Ⅱ型上皮细胞的表面细胞和间质圆形细胞排列成实性和乳头状结构,伴硬化性和出血性区域,切面质地不均匀、多彩状,一般都有褐色区。11例行电视胸腔镜外科手术治疗,其余2例未行手术治疗,给予止咳祛痰等对症治疗。截至随访结束所有患者均正常生活。结论PSP多见于女性,发病年龄范围较广,临床表现无特异性,结合影像学表现、常规病理学检查和免疫组织化学可明确诊断。其生物学行为相对模糊,手术治疗预后良好,对手术和非手术患者都应密切随访。Objective To analyze the clinical characteristics of pulmonary sclerosing pneumocytoma(PSP).Methods This was an observational study.Thirteen PSP patients who were pathologically diagnosed at the Affiliated Hospital of Jining Medical University from January 2010 to August 2022 were enrolled using a non-random sampling method.Clinical data of all patients were collected,including basic information,clinical manifestations,laboratory testing results,imaging findings,diagnostic methods,pathological features,treatment,and follow-up.Follow-up was conducted until November 2023 via outpatient visits and telephone contact.Results All enrolled 13 PSP patients were female,with the median age of 58(30-72)years.Three patients had no respiratory symptoms and they were diagnosed through health examinations.Eight cases presented symptoms of coughing and sputum production,of which 1 case occasionally had blood in the sputum.One case had dry cough,and another presented dull pain in the lower left rib area.The laboratory test results of all patients were normal.Computer tomography(CT)showed single nodules in 8 cases,multiple nodules in both lungs in 4 cases,and multiple patchy soft tissue density shadows in 1 case.Circular or quasi-circular lesions were seen in 12 cases,with 10 cases having smooth edges and clear boundaries,1 case showing burr shadows at the edges,and 1 case showing patchy ground glass density shadows around the edges.Enhanced CT scanning showed 2 cases of mild enhancement,2 cases of moderate enhancement,3 cases of high enhancement,and 6 cases of uneven enhancement.There were 5 cases of positive vascular edge sign,1 case of peripheral bronchial bypass,and 2 cases of calcification.One case was diagnosed through ultrasound-guided bronchial needle aspiration biopsy,and 2 cases were diagnosed through CT guided percutaneous lung biopsy.The remaining 10 cases were all confirmed by surgery,including 6 cases diagnosed by rapid pathological examination during surgery.Seven cases were confirmed by routine pathological examina

关 键 词：肺肿瘤 硬化性肺泡细胞瘤 临床特征 影像学表现 病理特征 免疫组织化学 

分 类 号：R734.2[医药卫生—肿瘤]