胸膜孤立性纤维性肿瘤的诊断及外科治疗

Diagnosis and surgical treatment of solitary fibrous tumor of pleura

目的探讨胸膜孤立性纤维性肿瘤(SFTP)的诊断及治疗方法。方法回顾9例胸腔肿瘤手术切除后病理确诊为SFTP的病例,就其诊断和治疗方法进行分析。结果 9例中,6例有咳嗽胸闷等症状,1例伴有严重低血糖,2例无明显症状体检发现。CT检查表现为包膜完整光滑的类圆形阴影,可伴有胸腔积液。术中探查肿瘤8例位于脏层胸膜,1例位于壁层胸膜。手术完整切除肿瘤,合并肺楔形切除1例,肋骨部分切除1例。肿瘤最大直径3～30cm。镜下SFTP由大量梭形细胞构成,间质含有大量粗细不等的胶原纤维。免疫组化结果 CD34阳性率为100%,Bcl-2阳性率为83.3%。结论早期SFTP大多无明显症状,诊断比较困难。压迫症状及低血糖症状的出现,应当高度怀疑SFTP。CT检查是重要的诊断手段。手术切除肿瘤是治疗SFTP的最好方法。确诊有赖于病理及免疫组织化学检查。

Objective To summaerize the diagnosis and treatment of solitary fibrous tumor of pleura （SFTP）.Methods Data of nine patients with SFTP were analyzed retrospectively.Results Of nine SFTP patients,six cases had cough,dyspnea and other symptoms,one had episodic hypoglycemia,two cases were found by physical examination.The tumors were round solitary shade with clear margin on CT image.Some cases had pleural effusion.Eight tumors located in the visceral pleura and one in parietal pleura.All patients underwent surgery with full excision of the tumors.One tumor was excised together with wedge resection of the lung and another case with partial lib resection.The tumors sized from 3 to 30 cm and mainly were consisted of spindle shaped cells with abundant gross collagenous fibers around.The tumor cells were stained with CD34（positive rate 100%） and Bcl-2（positive rate 83.3%）.Conclusion Although the early stage of SFTP appears to have no evident symptom,it should be highly suspected when it presents new symptoms caused by tumors.CT is valuable for qualitative diagnosis of SFTP.Complete resection of the tumor is the most effective way in the teatment of SFTP.The final diagnosis is based on histopathological and immunohistochemistry examination.