肺硬化性血管瘤10例临床分析

An analysis of the clinical and pathological features of 10 patients with pulmonary sclerosing hemangioma and review of the literature

目的 通过探讨肺硬化性血管瘤 (PSH)的临床、X线及病理特征 ,提高对PSH的认识。方法 对 10例手术病理证实的PSH患者的临床和肺部X线表现及病理资料作一回顾性分析。结果 男女之比为 1∶4 ,年龄 2 4～ 5 7岁 ,平均 4 0岁。有 6例患者无症状 ,4例患者有症状 (咳嗽 4例 ,胸痛 3例 ,咳血丝痰 2例 ,间歇性低热 1例 )。X线胸片多表现为孤立性、圆形或卵圆形、密度均匀、境界清楚、边缘光滑的结节状阴影。肿瘤直径范围为 1.5～ 6 0cm。病灶内均无钙化 ,亦无肺门及纵隔淋巴结肿大。病理 :肉眼见肿瘤局限 ,均有假包膜。切面呈灰、黄色 ,有散在出血灶。光镜下肿瘤主要有 4种改变 :实性圆性细胞片区、乳头样突起、血管瘤样改变或出血灶及硬化。结论 对中青年女性 ,尤其是胸部X线片表现为密度均匀、境界清楚、边缘光滑的圆形或类圆形结节且无钙化、无肺门淋巴结肿大者应考虑本病。

Objective To investigate the clinical, radiographic and pathological features of pulmonary sclerosing hemangioma (PSH). Methods The clinical features, radiographic manifestations and pathological findings of 10 patients with PSH were reviewed. Results There were 2 male and 8 female in this group with age ranging from 24 to 57 years (average age,40 years) .Six cases were symptom free,their pulmonary tumors were discovered on routine check up of chest roentgenograms . Four cases had symptoms (4 cough, 3 chest pain, 2 blood tinged sputum and one intermittent low fever). The plain chest roentgenograms showed a solitary, well defined, homogeneous, round or oval nodulous shadow in most cases. The long diameter of the tumors ranged from 1.5 cm to 6.0 cm. No calcification was observed in the tumors and also no lymphadenectasis in the hilar region or mediastinum. None of the 10 patients was diagnosed as PSH preoperatively. On gross appearance the tumors were well circumscribed, surrounded by a pseudocapsule, and with the cut surface usually showing a grey to yellow tinge and scattered reddish brown areas. Sections from the resected tumor showed histologically solid, papillary, hemangiomatous and sclerotic patterns. Conclusion PSH should be suspected in young to middle aged female patients who showed a solitary, well defined, homogeneous, round or oval shadow in plain chest roentgenograms with no calcification and no lymphadenectasis in the hilar region or mediastinum.