肺癌肉瘤与肺母细胞瘤的临床分析及文献复习

The clinical analysis and review of literature of pulmonary carcinosarcoma and blastoma

目的 探讨肺癌肉瘤与肺母细胞瘤的临床特点、诊断、治疗方法，以提高其诊断率。方法 回顾性地总结自１９７９ 年１ 月～１９９８ 年１１ 月收住的肺癌肉瘤１５ 例，肺母细胞瘤２ 例，并结合文献对其组织发生、临床表现、诊断及治疗方法进行分析。结果 肺癌肉瘤及肺母细胞瘤均为肺内罕见的恶性肿瘤，镜下均可见上皮及间质两种成分，但又有其不同之处，手术前很难确诊。肺癌肉瘤主要症状为咳嗽、咳痰、血丝痰等。 Ｘ 线示以周围型居多。病灶大小约在２ ～５ ｃｍ 之间。病灶密度均匀，可见空洞，可为中心或偏心溶解，内壁不规则。病灶边缘清楚，有分叶，还可见肺门及纵隔淋巴结肿大。支气管镜检查可见肿物阻塞管腔，或支气管狭窄，活检可见鳞癌、腺癌及大细胞癌。痰中亦可查到癌细胞，故极易与肺癌相混淆。１４ 例行手术治疗并确诊，１ 例经淋巴结活检证实为肺癌肉瘤。肺母细胞瘤表现为发热（２／２） 、咯血（１／２） ， Ｘ 线及 Ｃ Ｔ 表现为肺内肿块，密度不均匀，１ 例胸腔积液中查见恶性肿瘤细胞，无法确诊，行肺穿刺活检确诊。１ 例行肺叶切除术后病理确诊，全组术后随访１５ 例（２ 例癌肉瘤失访） ，随访率８８ ％ 。其中４ 例（ 包括１ 例肺母细胞瘤） 随访时仍健在。癌肉瘤１ 年生存率为３?

Objective To explore the clinical characteristics, diagnosis, treatment of pulmonary carcinosarcoma and blastoma Methods Summarizing retrospectively 15 cases of pulmonary carcinosarcoma and 2 cases of pulmonary blastoma from January 1979 to November 1998, and reviewing literature to analyse their histologic, clinical feature,diagnosis and treament Results Pulmonary carcinosarcoma and blastoma both were found to be rare malignant tumors, and both epithelial and mesenchymal elements can be seen under the microscopy with different characteristic features It was hard to be diagnosed before operation The main symptoms of pulmonary carcinosarcoma were cough, expectoration, sometimes bloody phlegm X ray showed that peripheral type were most common, and 2～5 cm in size, well distributed in density, some showed central or eccentric cavities whose wall was irregular The margin of the focuses were clear, leafy, the distensive lymph nodes of hilum or mediastium could also be seen Bronchoscopic examination revealed the bronchial cavity was obstructed by mass or became stricted Local biopsy can found squamous, adenocarcinoma or large cell carcinoma, respectively Malignant cell can also be found in sputum So it was easy to be confused with lung cancer 14 cases of the carcinosarcoma were treated surgically and diagnosed, 1 case was diagnosed by lymph node biopsy The symptoms of pulmonary blastoma were fever and hemoptysis X ray or CT scan showed an isolated mass in the lung, with uneven density Malignant cells in pleural effusion were found in one case and can not be diagnosed definetely but by pulmonary puncture The another case was diagnosed by surgical operation 15 cases of this group were followed up, in which 4 cases are still alive(including 1 case of pulmonary blastoma),the 1 year survival of carcinosarcoma is 30% (3/10) ,2 year survival 20%(2/10),in which 1 case survived more than 6 years Another pulmonary blastoma case only survived 3 months Conclusions These 2 kinds of malignant tumor are often easy to be misdiagnosed, and prognosis is very poor Surgical resection is the main method of diagnosis and treatment