肺良性转移性平滑肌瘤1例报道及文献复习

Pneumonic benign metastasizing leiomyoma:a case report and review of literature

目的分析肺良性转移性平滑肌瘤(benign metastasizing leiomyoma,BML)的临床和组织病理学特点,研究其免疫组化表型,讨论诊断和鉴别诊断。方法对1例BML进行光镜观察及免疫组化标记,并复习文献。结果中年女性患者,有子宫平滑肌瘤手术史,胸部CT示右肺多发性结节。切除标本见2个灰白色结节,直径分别为6 cm、1.2 cm,边界清楚,镜下见肿瘤细胞较丰富,并见上皮衬覆的管腔样结构,未见坏死及核分裂象,与原发子宫平滑肌瘤形态相似。免疫组化证实为平滑肌源性,且表达雌激素受体。结论BML是一种罕见的疾病,多发生在有子宫平滑肌瘤病史的女性,转移部位主要是肺,组织学形态表现良性,手术切除是主要治疗方法。

Purpose To investigate the clinical and pathological features of pneumonic benign metastatic leiomyoma（BML）,discuss the diagnosis and differential diagnosis of BML with a deep research of the phenotype of IHC.Methods One case of BLM were investignetd by lighe microscopy,immunohistochemistry and review of literature.Results A middle age woman had a history of leiomyoma of uterus incision and CT scan shows several nodes in lung.Two gray-whitish nodes were found in the removal specimen,6 cm、1.2 cm in respectively diameter,and well demarked from the around tissue.The neoplasia is plenty of tumor cells,some lumenoid structure lined with epithelium in the tumor tissue.Tumor cells is well differentiated and look like smooth muscle cells without the necrosis and karyokinesis.The pattern of tumor is similar to the original tumor.IHC assay identified it originates from smooth muscle cell,with an expression of ER.Conclusions BML is rare,most of the patients suffered from leiomyoma of uterus before.It is preferential to metastasize to lung and represents benign.Surgical resection is the effective method.