支气管和食管同时受累的炎症性肌纤维母细胞瘤1例报告

Inflammatory myofibroblastic tumor with simultaneous involvement of bronchus and esophagus: A case report and literature review

目的炎症性肌纤维母细胞瘤相对少见,本文探讨炎症性肌纤维母细胞瘤的病因、诊断、治疗及预后,以提高对本病的认识。方法对解放军总医院呼吸内科2018年收治的1例支气管和食管同时受累的炎症性肌纤维母细胞瘤患者的临床和影像学特点进行分析,并结合文献复习进行讨论。结果患者男性,53岁,以干咳、活动后喘憋为主要表现。支气管镜检查提示左主支气管新生物,肺CT提示左肺不张。患者2017年10月在外院因"食管肿瘤"手术,术后病理切片于解放军总医院病理科会诊,考虑为炎症性肌纤维母细胞肿瘤(低度恶性)。给予支气管镜下氩等离子体凝固术、高频电刀切除术等介入综合治疗,术后临床症状明显改善,肺部影像学检查示左肺复张,治疗过程中无严重并发症发生。术后病理符合炎症性肌纤维母细胞瘤改变。结论炎症性肌纤维母细胞瘤属少见的低度恶性肿瘤,支气管和食管同时受累者更为少见。明确诊断需依靠组织病理学检查,治疗以手术切除为首选,无手术机会的患者若有气道阻塞及肺不张等临床表现,可以经气管镜下介入治疗并辅以放化疗等综合治疗措施。

Objective To explore the etiology,diagnosis,treatment and prognosis of inflammatory myofibroblastoma(IMT)and improve understanding of this disease.Methods Clinical and imaging characteristics of an IMT patient with simultaneous involvement of respiratory and digestive system in Chinese PLA General Hospital in 2018 were analyzed and related literatures were reviewed.Results The patient was a 53-year-old male and mainly presented with dry cough and wheezing after exercise.Bronchoscopic examination in local hospital showed a neoplasm in left main bronchus and lung CT showed left lung atelectasis.Then he was referred to Chinese PLA General Hospital for further treatment.The patient had undergone surgery because of esophageal tumor in other hospital in October,2017,and diagnosed as inflammatory fibroid polyp.However,pathology consultation from our hospital considered it as inflammatory myofibroblastoma(low malignant potential).Interventional therapy such as bronchoscopic argon plasma coagulation(APC)and high frequency electric knife resection were given.The clinical symptoms were improved obviously after operation.The imaging examination showed that the left lung was dilated.No serious complication occurred during the treatment.Postoperative pathological result was in accordance with inflammatory myofibroblastic tumor.Conclusion Inflammatory myofibroblastoma is a rare low-grade malignant tumor,especially in patients with simultaneous bronchial and esophageal involvement.The definitive diagnosis depends on histopathological examination,and surgery is the first choice.If the patient has no chance of operation,such clinical manifestations as airway obstruction and pulmonary atelectasis can be treated by endoscopic intervention combined with radiotherapy and chemotherapy.