14例肺炎性肌纤维母细胞瘤的临床病理研究

A clinicopathological study of 14 cases of pulmonary inflammatory myofibroblastic tumor

背景与目的 炎性肌纤维母细胞瘤（Inflammatory myofihroblastic tumor，IMT）是一种较为少见的好发于肺脏的真性肿瘤。本文旨在探讨肺IMT的外科临床病理特点及治疗和预后。方法 自1999年1月至2003年12月，同济医院胸心外科共收治14例肺IMT患者。切除标本均经病理组织学、免疫组织化学检查确立诊断。所有患者均接受1～5年的随访。结果 14例患者中男性8例，女性6例，年龄11～46岁。9例患者无临床症状。5例表现为咳嗽、咳血及气短等症状。IMT的诊断均通过外科切除后病理检查确立。切除肿瘤大小从1～8cm不等。病理组织学上IMT主要由梭形细胞和各种炎性细胞组成，梭形细胞在超微结构上表现为肌纤维母细胞和纤维母细胞。本组所有患者手术切除后无临床复发，随访预后良好。结论 病理组织学上。IMT是以肌纤维母细胞混以各类炎性细胞为特征，其中包括浆细胞、淋巴细胞和组织细胞。外科手术完整切除肿瘤是治疗IMT的首选方法并且预后良好。

Background and objective Inflammatory myofibroblastic tumor （IMT） is an uncommon disease which usually occurs in the lung. Recently, several reports have suggested that IMT is a true neoplasm rather than a reactive lesion. In this retrospective study, we reviewed clinicopathological characteristics and prognoses of patients with surgically resected IMT of the lung at our department. Methods From January 1999 to December 2003, 14 patients had surgical intervention for IMT of the lung at Tongji Hospital. The resected lesions were studied histologically and immunohistochemically. One to 5 years＇ follow-up was completed in all patients. Results These 14 patients included eight men and six women. They ranged in age from 11 to 46 years old. Nine patients were asymptomatic. The other five symptomatic patients had cough, hemoptysis, and dyspnea. For all these patients, the diagnostic procedure was surgical excision. The resected tumor size ranged from 1.0 to 8.0 cm in diameter. Histologically, a variety of inflammatory and spindle cells were observed. The spindle cells corresponded ultrastructurally to myofibroblasts or fibroblasts. There was no recurrence in these patients, and all of them were in good health during the follow-up. Conclusion Histopathologically, IMT is characterized by myofibroblasts which are mixed with chronic inflammatory cells, including plasma cells, lymphocytes, and histiocytes. Surgical resection, when possible, should be chosen as the first choice and complete resection leads to excellent survival.