先天性支气管囊肿的临床及病理分析

Clinical and pathological features of congenital bronchial cyst

目的 探讨先天性支气管囊肿的临床及病理特点。方法 回顾性分析我院 1997年 1月至 2 0 0 2年 1月经手术切除病理证实的 3 0例先天性支气管囊肿患者的临床及病理资料。结果 根据X线胸片、胸部CT检查结果 ,本组患者病灶肺内型 2 3例、纵隔型 5例、异位型 2例。其中液囊肿 18例、气囊肿 7例、多发肺囊肿 5例。肺内型多以并发感染就诊 ,其中 19例表现为咳嗽、咳痰 ,2例伴发热 ,11例表现为咯血或痰中带血 ,11例有不同程度的胸痛 ;CT特征为囊腔大、周围软组织少的“块中囊” ,或薄壁的空腔、多发性蜂窝状、囊腔状环行透光影。纵隔型 2例于体检时偶然发现 ,2例因囊肿压迫气管而出现胸闷、呼吸困难 ,1例压迫食管而出现吞咽梗塞感 ;CT特点为边界清楚、密度一致的孤立性圆形或卵圆形阴影 ,与周围器官组织相互挤压变形。异位型 2例均于体表扪及囊性包块就诊。病理检查 :镜下均可见假复层纤毛柱状上皮、腺体、软骨、弹力纤维和少量平滑肌。结论 先天性支气管囊肿以肺内型为多 ,临床表现主要为咳嗽、咳痰及咯血 ,CT检查以块中囊为其特征性表现 ;组织病理学检查均具备呼吸上皮、腺体、软骨和平滑肌。

Objective To study the clinical and pathological features of congenital bronchial cysts Methods The clinical, X ray, CT and histopathologic manifestations were retrospectively reviewed in 30 patients with congenital bronchial cysts Results There were 23 patients with intrapulmonary bronchogenic cysts, 5 patients with mediastinal bronchogenic cysts, and 2 patients with ectopic bronchogenic cysts Of the 30 patients, 18 were liquid cysts, 7 air cysts, and 5 multiplepulmonary cysts Intrapulmonary congenital bronchial cysts were diagnosed always due to infection Nineteen of 23 patients (83%) presented with cough, sputum production, 2 accompanied by fever, 11 with hemoptysis or blood stained sputum, 11 with chest pain The imaging features were 'bag included mass', which was characterized by a big bag surrounded by a little soft tissue, or thin walled cavity, or multiple honeycomb or cystoid circular translucency Two of 4 patients with mediastinal bronchogenic cysts incidentally discovered on a radiograph obtained for other reasons were almost asymptomatic, 2 presented with dyspnea due to compression of trachea, 1 with dysphagia due to compression of oesophagus The imaging features included isolated well defined round shape or ovoid soft tissue mass with isodensity, and mutual compression between the surrounding organs Two patients with ectopic bronchogenic cysts were diagnosed due to cystic mass on chest wall Pseudostratified ciliated columnar epithelium, gland, cartilage, elastic fiber and smooth muscle were all confirmed by light microscopy Conclusions The main type of congenital bronchial cysts is intrapulmonary bronchogenic cysts. The clinical manifestations are cough, sputum production and hemoptysis, and the imaging feature is 'bag included mass' on CT scan A lining of respiratory epithelium associated with a wall containing glands, cartilage and smooth muscle is the histopathologic feature for diagnosing congenital bronchial cysts The optimal treatment is surgical resection