肺炎性假瘤的外科治疗
作者：林一丹 蒋耀光 范士志 肖华亮 李志平
单位：第三军医大学大坪医院(400042)
关键词：肺炎性假瘤；肺癌；硬化性血管瘤；肺泡细胞瘤；神经内分泌肿瘤
重庆医学000401摘 要：目的探讨肺炎性假瘤的临床特征、误诊原因及治疗方法。方法回顾分析我科在1989～1999年十年间手术治疗的30例肺炎性假瘤病历并重新观察病理切片。结果一部分病例与炎症有一定的联系，一部分病例具有明确的局部侵犯行为。术前21例(70%)误诊为肺癌，仅9例(30%)考虑到炎性假瘤且不能排除肺癌。全组均行手术治疗，术后除1例并发支气管胸膜瘘短期治愈外余均顺利恢复。23例随访6个月～5年，2例死亡，存活的21例病灶无复发。结论肺炎性假瘤是一大类未能细分的多种病变的总称而并非一种单一的病变，其中二部分可能是真性肿瘤。诊断上很难与肺癌和低度恶性纤维肉瘤鉴别。治疗应以及早手术、彻底切除病灶、尽量保存健肺组织为原则。对光镜发现大量梭型细胞浸润的病例应随访。
, http://www.100md.com
Surgical Treatment for Inflammatory Pseudotumors of the Lung:With a report of 30 Cases
Lin Yidan ,Jiang Yaoguang ,Fan Shizhi ,Xiao Hualiang ,Li Zhiping
(Department of Cardiotboracic Surgery, Third Hospital and Surgery Research Institute, Third Military Medical University, Chongqing 400042)
Abstract： Aim:To discuss the etiolegy and surgical treatment of the inflammatory peseudotumors of the lung(IPL). Methods:30 cases of IPL surgically treated from 1989 to 1999 were reviewed. Results:Some cases had the evidence of inflammation while others had marked local invasion.All patients received surgery, including wedge or segmental resection in 11 cases, lobectomy in 15, pneumonectomy in 3 and exploration in 1.Preoperatively, 21(70%) cases were misdiagnosed as lung cancer or tuberculoma, only 9(30%) cases were suspected having IPL while lung cancer could not be excluded.There were no postoperative mortality and complications except one, who suffered from bronchopleural fistula but was cured soon after, half to five years follow up was given to 23 cases. Among them 2 cases died while the others were still alive without recurrence.Conclusion:Most probably, IPL is a ferm which includes diverse group of lesions that neither appear to be etiologically related nor can be subclassified under light microscope.Some of IPL may be real tumor. It is difficult to distinguish IPL from pulmonary adenocarcinoma and low grade sarcoma. Complete surgical resection should be performed as soon as diagnosis was made. Follow up should be given to the cases who have predcrninant infiltration of spindle cells under light microscope.
, 百拇医药
Keywords：Inflammatory pseudotumors of the lung Lung cancer; Sclerosing hemangioma;Pneumocytoma;tumor
参考文献：
[1]崔忠厚，黄孝边，康澧源.26例肺炎性假瘤报告.中华胸心血管外科杂志，1989，5(1):35
[2]中国医学科学院病理科、外科胸组、诊断科.肺炎性假瘤(附41例报告).中华内科杂志，1978，1：9
[3]Robert J C, Mark SA, Antonio GM, et al. Inflammatory pseudotumors of the lung. Ann Thorac Surg, 1999, 67(4):933
, 百拇医药 [4]Satoh Y, Tsuchiya E. Weng SY. et al. Pulmonary sclerosing hemangioma of the lung: a type Ⅱ pneumocytoma by immunohistochemical and immnoelectron microscopic studies. Cancer, 1989, 64:1310
[5]李维华，许红民，李红芬.肺的一种良性神经内分泌肿瘤--对所谓肺硬化性血管瘤来源的探讨.中华病理杂志，1994，23：69李维华，许红民，李红芬.肺的一种良性神经内分泌肿瘤--对所谓肺硬化性血管瘤来源的探讨.中华病理杂志，1994，23：69
[6]Meis JM, Enxinger FM, Inflammatory fibrosarcoma of the mesenteryand retroperitoneum: a turnor closely simulating inflammatory pseudotumor. Am J Surg Pathol, 1991,15:1146
, 百拇医药
[7]Bahadori H, Averill A, Liebow. Plasma cell granulomas of the lung.Cancer, 1973, 31:191
[8]Wentworth P, Lynch M. J, Faillis, J. C, et al.: Xanthomatous pseudotumor of lung. A case report with electron microscope and lipid studies. Cancer, 1968, 22: 345
[9]Snyder CS, Dell AM, Haghighi, P, et al. Clonal changes in inflammatory pseudotumor of the lung:a case report. Cancer, 1995, 76(9):1545
[10]Hussong JW, Prown M, Sherrie L. Comparison of of DNA ploidy histologic, and immuno-histochemical findings with clinical outcome in inflammatory mrnatory myofibroblastic tumors. Mod Pathol, 1999,12(3):279
, 百拇医药
[11]Niho S;Suzuki K;Yokse T;et al. Monoclonality of both pale and cuboidal cells of sclerosing hemangioma of the lung.Am J Pathol,1998,152(4):1065
[12]Marie CC, Bemard HG, Michel ER. Plasma cell granuloma of the lung:difficulties in diagnosis and prognosis.Ann Thorac Surg,1996, 61:1477
[13]叶世时，仇欣荪.肺部炎性假瘤32例临床分析.中华结核和呼吸系统疾病杂志，1986, 9:149
[14]Christos A,Zbigniev O, David B F, et al. Case Reports: Inflammatory pseudotumors of the lung.Ann Thorac Surg, 1998, 66(3):948, 百拇医药
单位：第三军医大学大坪医院(400042)
关键词：肺炎性假瘤；肺癌；硬化性血管瘤；肺泡细胞瘤；神经内分泌肿瘤
重庆医学000401摘 要：目的探讨肺炎性假瘤的临床特征、误诊原因及治疗方法。方法回顾分析我科在1989～1999年十年间手术治疗的30例肺炎性假瘤病历并重新观察病理切片。结果一部分病例与炎症有一定的联系，一部分病例具有明确的局部侵犯行为。术前21例(70%)误诊为肺癌，仅9例(30%)考虑到炎性假瘤且不能排除肺癌。全组均行手术治疗，术后除1例并发支气管胸膜瘘短期治愈外余均顺利恢复。23例随访6个月～5年，2例死亡，存活的21例病灶无复发。结论肺炎性假瘤是一大类未能细分的多种病变的总称而并非一种单一的病变，其中二部分可能是真性肿瘤。诊断上很难与肺癌和低度恶性纤维肉瘤鉴别。治疗应以及早手术、彻底切除病灶、尽量保存健肺组织为原则。对光镜发现大量梭型细胞浸润的病例应随访。
, http://www.100md.com
Surgical Treatment for Inflammatory Pseudotumors of the Lung:With a report of 30 Cases
Lin Yidan ,Jiang Yaoguang ,Fan Shizhi ,Xiao Hualiang ,Li Zhiping
(Department of Cardiotboracic Surgery, Third Hospital and Surgery Research Institute, Third Military Medical University, Chongqing 400042)
Abstract： Aim:To discuss the etiolegy and surgical treatment of the inflammatory peseudotumors of the lung(IPL). Methods:30 cases of IPL surgically treated from 1989 to 1999 were reviewed. Results:Some cases had the evidence of inflammation while others had marked local invasion.All patients received surgery, including wedge or segmental resection in 11 cases, lobectomy in 15, pneumonectomy in 3 and exploration in 1.Preoperatively, 21(70%) cases were misdiagnosed as lung cancer or tuberculoma, only 9(30%) cases were suspected having IPL while lung cancer could not be excluded.There were no postoperative mortality and complications except one, who suffered from bronchopleural fistula but was cured soon after, half to five years follow up was given to 23 cases. Among them 2 cases died while the others were still alive without recurrence.Conclusion:Most probably, IPL is a ferm which includes diverse group of lesions that neither appear to be etiologically related nor can be subclassified under light microscope.Some of IPL may be real tumor. It is difficult to distinguish IPL from pulmonary adenocarcinoma and low grade sarcoma. Complete surgical resection should be performed as soon as diagnosis was made. Follow up should be given to the cases who have predcrninant infiltration of spindle cells under light microscope.
, 百拇医药
Keywords：Inflammatory pseudotumors of the lung Lung cancer; Sclerosing hemangioma;Pneumocytoma;tumor
参考文献：
[1]崔忠厚，黄孝边，康澧源.26例肺炎性假瘤报告.中华胸心血管外科杂志，1989，5(1):35
[2]中国医学科学院病理科、外科胸组、诊断科.肺炎性假瘤(附41例报告).中华内科杂志，1978，1：9
[3]Robert J C, Mark SA, Antonio GM, et al. Inflammatory pseudotumors of the lung. Ann Thorac Surg, 1999, 67(4):933
, 百拇医药 [4]Satoh Y, Tsuchiya E. Weng SY. et al. Pulmonary sclerosing hemangioma of the lung: a type Ⅱ pneumocytoma by immunohistochemical and immnoelectron microscopic studies. Cancer, 1989, 64:1310
[5]李维华，许红民，李红芬.肺的一种良性神经内分泌肿瘤--对所谓肺硬化性血管瘤来源的探讨.中华病理杂志，1994，23：69李维华，许红民，李红芬.肺的一种良性神经内分泌肿瘤--对所谓肺硬化性血管瘤来源的探讨.中华病理杂志，1994，23：69
[6]Meis JM, Enxinger FM, Inflammatory fibrosarcoma of the mesenteryand retroperitoneum: a turnor closely simulating inflammatory pseudotumor. Am J Surg Pathol, 1991,15:1146
, 百拇医药
[7]Bahadori H, Averill A, Liebow. Plasma cell granulomas of the lung.Cancer, 1973, 31:191
[8]Wentworth P, Lynch M. J, Faillis, J. C, et al.: Xanthomatous pseudotumor of lung. A case report with electron microscope and lipid studies. Cancer, 1968, 22: 345
[9]Snyder CS, Dell AM, Haghighi, P, et al. Clonal changes in inflammatory pseudotumor of the lung:a case report. Cancer, 1995, 76(9):1545
[10]Hussong JW, Prown M, Sherrie L. Comparison of of DNA ploidy histologic, and immuno-histochemical findings with clinical outcome in inflammatory mrnatory myofibroblastic tumors. Mod Pathol, 1999,12(3):279
, 百拇医药
[11]Niho S;Suzuki K;Yokse T;et al. Monoclonality of both pale and cuboidal cells of sclerosing hemangioma of the lung.Am J Pathol,1998,152(4):1065
[12]Marie CC, Bemard HG, Michel ER. Plasma cell granuloma of the lung:difficulties in diagnosis and prognosis.Ann Thorac Surg,1996, 61:1477
[13]叶世时，仇欣荪.肺部炎性假瘤32例临床分析.中华结核和呼吸系统疾病杂志，1986, 9:149
[14]Christos A,Zbigniev O, David B F, et al. Case Reports: Inflammatory pseudotumors of the lung.Ann Thorac Surg, 1998, 66(3):948, 百拇医药