肺良性转移性平滑肌瘤的影像及病理学对照研究(附6例报告)

Pulmonary benign metastasizing leiomyoma: report of six cases with imaging and pathology correlation

目的探讨肺良性转移性平滑肌瘤的影像学及病理学特点。方法回顾性分析6例肺良性转移性平滑肌瘤的术前X线、CT表现,并与病理学检查结果对照。结果有4例表现为双肺多发大小不等类圆形实性结节,边界清晰光整,与其他恶性肿瘤肺转移的影像表现相似,术后病理回报为良性平滑肌来源肿瘤,无恶性及增生活跃证据;有2例影像学表现较为特殊,为肺内较大的分叶状、椭圆形肿物伴双肺多发实性结节,伴有钙化及不均匀强化,病理学回报细胞生长较活跃,伴有细胞异型性和核分裂相。结论肺良性转移性平滑肌瘤大部分影像学表现为肺内多发边界清晰的实性结节,诊断需结合子宫肌瘤病史及手术史;病史及影像学表现不典型者,需通过术后病理学检查确诊。

Objective To discuss the imaging and pathology feature of pulmonary benign metastasizing leiomyoma. Methods Six cases of pulmonary benign metastasizing leiomyoma were reported. X-ray,CT imaging manifestation and pathological correlation were analyzed. Results Four cases showed well circumscribed multiple pulmonary nodules mimicking lung metastases from other malignant tumors. Pathological examination reported a proliferation of cytologically benign smooth muscle without anaplasia,and mitotic figures were rare. Two cases displayed unusual and rare imaging feature including lobulated,oval mass with scattered multiple pulmonary nodules,and with calcification and inhomogeneous enhancement. Pathological examination represented mild active proliferation and positive anaplasia and mitotic figures. Conclusion Pulmonary benign metastasizing leiomyoma mainly showed the similar imaging character with lung metastases from malignant tumors. Those who had uterus leiomyoma history or undergone hysterectomy for leiomyomas should be considered this disease if multiple lung nodules were found. Those with unusual imaging findings needed a pathological examination to make a diagnosis.