原发性胸膜肉瘤样癌诊断学特征并文献复习

Diagnostic characteristics and literature review of primary sarcomatoid carcinoma of the pleura

目的探讨原发性胸膜肉瘤样癌诊断学特征。方法回顾性分析2018年6月24日济宁医学院附属医院呼吸与危重症医学科收治的1例原发性胸膜肉瘤样癌的临床资料,检索2010年至2019年中国知网、万方数据库、Pubmed数据库、Google学术的原发性胸膜肉瘤样癌的病例报道,结合文献复习,总结原发性胸膜肉瘤样癌临床特点、影像学、内镜及病理等诊断学特征。结果共收集7例患者病例资料,女性3例,男性4例,年龄47~49岁。临床表现以呼吸困难、胸痛为主。胸部CT平扫:胸膜增厚及软组织肿块,胸腔内见液体密度影;CT增强扫描:肿块轻度或中度强化;正电子发射计算机断层显像(PET-CT):病灶标准摄取值明显升高。胸腔镜:壁层胸膜表面见多发结节及团块样新生物。病理镜下:梭形异质细胞,苏木精-伊红染色结合免疫组织化学染色符合肉瘤样癌。结论原发性胸膜肉瘤样癌临床表现无特异性,影像表现为胸膜不规则肿块,胸腔镜可见胸膜增厚及新生物,但诊断依赖于较大标本组织病理活检及免疫组织化学染色分析。

Objective To explore the diagnostic characteristics of primary sarcomatoid carcinoma of the pleura.Methods The clinical data of a case of primary sarcomatoid carcinoma of the pleura in the Department of Respiratory and Critical Care Medicine in Affiliated Hospital of Jining Medical University on June 24,2018 was retrospectively analyzed.The 6 cases reports of primary sarcomatoid carcinoma of the pleura in CNKI,Wanfang Data,Pubmed and Google Scholar from 2010 to 2019 were searched,and the literatures were reviewed.The clinical,imaging,endoscopic and pathological diagnostic characteristics were summarized.Results Data of 7 patients were collected,including 3 females and 4 males,who were 47-49 years old,presenting with dyspnea and chest pain.Chest CT showed thickened pleura and soft tissue mass,with fluid density shadow in the pleural cavity.CT enhanced scan showed mild or moderate enhanced mass.Positron emission tomography(PET)-CT showed the standardized uptake value of lesions was significantly increased.Thoracoscope showed multiple nodal and nubbly neoplasm on the parietal pleura.Spindle heterogenous cells were shown under pathologic microscopy.HE staining combined with immunohistochemistry was consistent with sarcomatoid carcinoma.Conclusions The clinical manifestations of primary sarcomatoid carcinoma of the pleura are nonspecific.Imaging shows irregular mass on the pleura.Thoracoscope shows pleural thickening and neoplasm.But the diagnosis depends on histopathological biopsy and immunohisto-chemical analysis of larger specimens.