原发性肺脑膜瘤的影像学及病理特征分析

目的探讨原发性肺脑膜瘤的影像学和病理组织特征及鉴别诊断。方法回顾性分析10例原发性肺脑膜瘤患者的临床资料,对其影像学和病理组织学特征进行国内外相关文献资料复习。结果10例患者均为女性,年龄50~72岁,体检时偶发,无任何症状。其中2例呈磨玻璃结节,8例呈单发实性结节,结节均位于胸膜下。7例患者合并肺腺癌,术后均未予特殊治疗,随访1~4年,无复发或转移。胸腔镜下观察到原发性肺脑膜瘤由梭形细胞和上皮样细胞组成,出现漩涡状结构,核椭圆形,无异型性。结论原发性肺脑膜瘤极其罕见,良性多见,影像学上可表现呈磨玻璃结节或实性结节,胸膜下多见,在依据病理形态学和免疫组织化学可以明确诊断的基础上,首先应对转移性脑膜瘤进行鉴别诊断,首选手术切除治疗。

Objective To investigate the clinical and imaging features,pathological features and differential diagnosis of primary pulmonary meningioma.Methods A retrospective analysis of the clinical features of 10 cases of primary pulmonary meningioma was performed,and a review and study of relevant literature at home and abroad on their imaging and histopathological features was conducted.Results All 11 patients were female,age 50~72 years.They were all sporadic during physical examinations and had no symptoms.Among them,2 cases presented with ground glass nodules,8 cases were single solid nodules,and pulmonary meningioma nodules were all located under the pleura.Among the 10 cases,7 cases were complicated with lung adenocarcinoma,and no special treatment was given after surgery.Follow up for 1~4 years showed no recurrence or metastasis.Through microscopic observation,primary pulmonary meningioma was composed of spindle shaped cells and epithelioid cells,with a vortex-like structure and an elliptical nucleus,without atypia.Conclusion Primary pulmonary meningioma is extremely rare and often benign.It can appear as ground glass nodules or solid nodules on imaging,and is more common under the pleura.Based on the clear diagnosis based on pathological morphology and immunohistochemistry,differ ential diagnosis should be made for metastatic meningioma,and surgical resection is the preferred treatment.