肺肉瘤样癌文献复习及一例报道

doi:10.3877/cma.j.issn.1674-6902.2023.02.009

目的

分析肺肉瘤样癌(pulmonary sarcomatoid carcinoma)的临床特点及诊治方案，以提高对肺肉瘤样癌的认识。

方法

选择我院2021年12月1日收治的1例肺肉瘤样癌患者，行胸部CT、支气管镜活检、胸腔镜活检、B超引导下肺穿刺活检及剖胸探查，检索近10年相似病例的文献，进行分析。

结果

患者胸部CT示左侧胸腔不规则片状、团片状稍低、软组织混杂密度影，增强扫描呈边缘明显强化，内容物强化不明显，左肺组织受压，其内斑片状密度增高模糊影。胸腔镜、支气管镜及B超引导下肺穿刺活检为慢性炎症。开胸活检病理诊断为肺肉瘤样癌。

结论

肺肉瘤样癌发病率低，临床表现及影像学无特异性，小标本易漏诊和误诊，诊断主要依赖于病理学。临床应考虑该病可能，早发现、早诊断、早治疗，降低病死率。

关键词: 肺肉瘤样癌, 文献复习, 一例报道

Objective

Based on reported a case of pulmonary sarcomatoid carcinoma and reviewed the abovementioned diseases in recent years, to summarize the clinical features, diagnosis and treatment of this disease for improve the understanding of this disease.

Methods

Reported a case of pulmonary sarcomatoid carcinoma that we diagnosis and treatment, and retrieval of similar cases in rencent ten years in literature.Then summarizes the clinical features, diagnosis and treatment. Case: 1 months ago, the patient developed chest pain without obvious inductions, and the pain recurred, accompanied by streaks of blood in the sputum. Later, the chest pain gradually worsened. The patient was repeatedly referred to a local hospital, where tracheoscopy and thoracoscopy indicated pneumonia, and the symptoms were not significantly relieved after anti-inflammatory therapy. After being admitted to our hospital, the chest pain continued to worsen and became unbearable. Chest CT showed space occupying in the left thoracic cavity, and tracheoscopy and B-ultrasound guided puncture failed to identify the cause. Due to the progressive decline of hemoglobin, a thoracotomy was decided after multidisciplinary consultation.

Results

The exploratory thoracotomy was confirmed as pulmonary sarcomatoid carcinoma. Patient was not treated and leaves hospital after diagnosis. After a few days the disease progressed and the patient died at home.

Conclusions

The incidence of pulmonary sarcomatoid carcinoma is extremely low, The clinical and imaging manifestations of pulmonary sarcomatoid carcinoma are not specific.he diagnosis mainly depends on pathology, and is easy to be misdiagnosed as other common lung cancer. It should be paid enough attention to these diseases in clinical practice.

Key words: Pulmonary sarcomatoid carcinoma, Literature review, Case report

图1 院外胸部CT(2021年11月7日)示：左肺下叶斑片状高密度影，少量胸腔积液

图2 院外胸部CT(2021年11月26日)示：左肺下叶节段性不张可能，左侧包裹性胸腔积液

图3 胸部CT(2021年11月30日)示：左侧胸腔不规则片状，软组织混杂密度影，左肺组织受压，其内斑片状密度增高模糊影

图4 胸片及超声图；注：A：床旁胸片(2021年12月6日)左侧胸腔大片高密度影；B：床旁胸片(2021年12月9日)左侧胸腔大片高密密度影；C：床旁超声(2021年12月14日)肝脏多发转移(红色箭头)

图5 我院胸部CT(2021年12月7日)示：左侧胸腔不规则片状，软组织混杂密度影较2021年11月30日增大

图6 胸腔大量血性液体，伴肉样新生物，紧贴胸壁和肺表面

图7 恶性肿瘤伴出血、坏死，结合形态学及免疫表型符合肉瘤样癌(HE染色　×200)

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Pulmonary sarcomatoid carcinoma: a case report and review of the literature

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Pulmonary sarcomatoid carcinoma: a case report and review of the literature