中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

原发性气管或肺恶性血管球瘤的临床特点

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目的探讨原发性气管或肺恶性血管球瘤(MGT)的临床特点。方法通过报道本院 1 例原发性气管 MGT,并检索国内外数据库检索已发表的原发性气管或肺 MGT 的案例,对其临床表现、影像学表现、气管镜表现、病理学表现尤其是免疫组织化学特点、诊断及鉴别诊断、治疗和预后进行归纳总结。结果患者男性,咳嗽、胸闷、气促、呼吸困难。气管内 MGT,气管镜下射频消融+冷冻治疗,患者拒绝化疗,双肺转移,术后 2 个月死亡。检索到 16 篇文献共 17 例原发性气管或肺 MGT,其中 5 例原发于气管,12 例原发于肺。其临床表现、影像学表现、气管镜表现无特异性,诊断主要依靠病理学尤其是免疫组织化学染色结果。气管 MGT 的治疗首先考虑外科手术节段切除,其预后尚可。肺 MGT 的治疗有肺叶切除术或气道介入治疗,其预后均较差。目前原发于气管或肺 MGT 的治疗,需早期治疗,由于气道介入及化疗的疗效不确切,治疗仍需首先考虑外科手术切除。结论原发性气管或肺 MGT 为罕见病,其临床表现、实验室检查及影像学无特征性表现,极易漏诊、误诊,最终需依靠活检进行病理学分析尤其是免疫组织化学染色分析以明确诊断,其治疗方法仍有待进一步探讨。

ObjectiveTo investigate the clinical features of primary tracheal or pulmonary malignant glomus tumor (MGT).MethodsA patient with primary tracheal MGT was reported. Wanfang, CNKI, Embase, Ovid, Cochrance and PubMed databases were searched with key words "tracheal malignant glomus tumor" and " pulmonary malignant glomus tumor” both in English and in Chinese for literature of primary tracheal or pulmonary MGT. Their clinical manifestations, imaging findings, bronchoscopic findings, pathological findings, especially immunohistochemical characteristics, diagnosis and differential diagnosis, treatment, and prognosis of primary tracheal or pulmonary MGT were summarized.ResultsThis male patient who manifested as cough, chest tightness, shortness of breath and dyspnea was diagnosed as tracheal MGT and received a treatment of radiofrequency ablation and cryotherapy under bronchoscopy. He refused to receive the chemotherapy and died after two months with a lung metastases. A total of 17 cases of primary tracheal or pulmonary MGT were retrieved in 16 articles, of which 5 were primary in the trachea and 12 were primary in the lung. Their clinical manifestations, imaging findings, and bronchoscopic findings were non-specific. The diagnosis relied on pathology, especially immunohistochemical staining. The preferred treatment of tracheal MGT may be surgical resection, the prognosis was acceptable. Treatment of lung MGT included lobectomy or airway interventional treatment and its prognosis was poor. The treatment of primary tracheal or pulmonary MGT needed early treatment. Because the curative effect of airway interventional treatment and chemotherapy was dubious, surgical plan should be first considered.ConclusionsBoth of primary tracheal and primary pulmonary MGT are rare. They usually lack specific clinical manifestations, laboratory tests, and imaging, and are easy to be misdiagnosis or miss diagnosis. The diagnosis can be confirmed by the results of biopsy for pathological analysis, especially by the immunohistochemical staining analysis. The treatment of tracheal and pulmonary MGT need further study.

关键词: 原发性; 气管; ; 恶性血管球瘤

Key words: Primary; Tracheal; Lung; Malignant glomus tumor

引用本文: 黄斌, 陈法桂, 梁健欣, 蔡俊福, 王少洪, 林黛英, 谢灿茂. 原发性气管或肺恶性血管球瘤的临床特点. 中国呼吸与危重监护杂志, 2018, 17(5): 477-483. doi: 10.7507/1671-6205.201710018 复制

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1. Schiefer TK, Parker WL, Anakwenze OA, et al. Extradigital glomus tumors: a 20-year experience. Mayo Clin Proc, 2006, 81(10): 1337-1344.
2. Gombos Z, Zhang PJ. Glomus tumor. Arch Pathol Lab Med, 2008, 132(9): 1448-1452.
3. Zhang Y, Li H, Zhang WQ. Malignant glomus tumor of the esophagus with mediastinal lymph node metastases. Ann Thorac Surg, 2013, 96(4): 1464-1466.
4. Folpe AL, Fanburg-Smith JC, Miettinen M, et al. Atypical and malignant glomus tumors: Analysis of 52 cases, with a proposal for the reclassification of glomus tumors. Am J Surg Pathol, 2001, 25(1): 1-12.
5. Lamba G, Rafiyath SM, Kaur H, et al. Malignant glomus tumor of kidney: The first reported case and review of literature. Hum Pathol, 2011, 42(8): 1200-1203.
6. 刘乔飞, 师杰, 黄城, 等. 主气道恶性血管球瘤 1 例. 中华胸心血管外科杂志, 2015, 31(2): 117, 128.
7. 王寿扬, 曾庆思, 陈淮, 等. 气管非典型血管球瘤 1 例. 中国医学影像技术, 2015, 25(7): 1018.
8. Huang C, Liu QF, Chen XM, et al. A malignant glomus tumor in the upper trachea. The Annals of thoracic surgery, 2015, 99(5): 1812-1814.
9. Braham E, Zairi S, Mlika M, et al. Malignant glomus tumor of trachea: A case report with literature review. Asian Cardiovasc Thorac Ann, 2016, 24(1): 104-106.
10. 黄斌, 陈法桂, 庄嘉, 等. 经病理诊断的原发性气管和肺恶性血管球瘤一例并文献复习. 中华结核和呼吸杂志, 2017, 40(9): 697-702.
11. Mackay B, Legha SS, Pickler GM. Coin lesion of the lung in a 19-year-old male. Ultrastruct Pathol, 1981, 2(3): 289-294.
12. Gaertner EM, Steinberg DM, Huber M, et al. Pulmonary and mediastinal glomus tumors--report of five cases including a pulmonary glomangiosarcoma: A clinicopathologic study with literature review. Am J Surg Pathol, 2000, 24(8): 1105-1114.
13. Hishida T, Hasegawa T, Asamura H, et al. Malignant glomus tumor of the lung. Pathol Int, 2003, 53(9): 632-636.
14. Kleontas A, Barbetakis N, Asteriou C, et al. Primary glomangiosarcoma of the lung: A case report. J Cardiothorac Surg, 2010, 5(76).
15. Zhang Q, Wang S, Divakaran J, et al. Malignant glomus tumour of the lung. Pathology, 2010, 42(6): 594-596.
16. 毛荣军, 李启明, 房惠琼. 肺部恶性血管球瘤 1 例临床病理分析. 临床与实验病理学杂志, 2012, 28(1): 90-92.
17. Hohenforst-Schmidt W, Woitow M, Zarogoulidis P, et al. Glomus tumor in the lung parenchyma. J Thorac Dis, 2012, 4(6): 663-666.
18. Wang S, Ding C, Tu J. Malignant glomus tumor of the lung with multiple metastasis: A rare case report. World J Surg Oncol, 2015, 13(22).
19. Dong LL, Chen EG, Sheikh IS, et al. Malignant glomus tumor of the lung with multiorgan metastases: Case report and literature review. Onco Targets Ther, 2015, 8: 1909-1914.
20. Cunningham JD, Plodkowski AJ, Giri DD, et al. Case report of malignant pulmonary parenchymal glomus tumor: Imaging features and review of the literature. Clin Imaging, 2016, 40(1): 144-147.
21. 李传旺, 马小敏, 林荣良. 肺恶性周围神经鞘膜瘤 1 例. 中国临床医学影像杂志, 2005, 16(6): 356.
22. Tashiro T, Kawakita C, Takai C, et al. Primary pulmonary malignant peripheral nerve sheath tumor: A case report. Acta Cytol, 2007, 51(5): 820-824.
23. Kitamura S, Kataoka Y, Fukutomi H, et al. Tracheal obstruction caused by cervical malignant peripheral nerve sheath tumor. Jpn J Clin Oncol, 2015, 45(9): 892-893.
24. 彭李博, 魏雪, 时姗姗, 等. 肺原发原始神经外胚叶肿瘤的临床病理观察. 医学研究生学报, 2015, 28(3): 277-279.
25. Dong M, Liu J, Song Z, et al. Primary multiple pulmonary primitive neuroectodermal tumor: Case report and literature review. Medicine (Baltimore), 2015, 94(27): e1136.
26. Asker S, Sayir F, Bulut G, et al. Primitive neuroectodermal tumor/ewing sarcoma presenting with pulmonary nodular lesions. Case Rep Oncol Med, 2015, 2015: 957239.
27. Zheng GY, Xie BS, Yue WX, et al. [peripheral primitive neuroectodermal tumor of trachea: A case report and review of literatures]. Zhonghua Jie He He Hu Xi Za Zhi, 2012, 35(11): 814-818.
28. 赵丹, 曲杨, 穆晶, 等. 肺血管肉瘤临床病理观察. 诊断病理学杂志, 2012, 19(6): 450-453.
29. Ren Y, Zhu M, Liu Y, et al. Primary pulmonary angiosarcoma: Three case reports and literature review. Thorac Cancer, 2016, 7(5): 607-613.
30. Chen JS, Chang YL, Shu HS, et al. Surgical treatment of a primary tracheal angiosarcoma. J Thorac Cardiovasc Surg, 2003, 125(1): 191-193.
31. Shim YS, Choi SJ, Kim HS, et al. Solitary fibrous tumor of the trachea: CT findings with a pathological correlation. Korean J Radiol, 2008, 9(3): 286-289.
32. Ichiki Y, Kakizoe K, Hamatsu T, et al. Solitary fibrous tumor of the lung: a case report. Surg Case Rep, 2017, 3(1): 10.
33. 程功文, 黄文勇, 向海鸿, 等. 气管孤立性纤维性肿瘤 1 例. 中国介入影像与治疗学, 2016, 13(10): 650.
34. 丁洪基, 隋中媛, 王贵珍, 等. 肺恶性孤立性纤维性肿瘤 1 例并文献复习. 临床与实验病理学杂志, 2015, 31(3): 325-327.
35. 施晓倩, 臧远胜, 王良哲, 等. 肺血管外皮瘤一例并文献复习. 中国呼吸与危重监护杂志, 2013, 12(5): 468-471.
36. Akman T, Alacacioglu A, Dolek D, et al. Malign recurrence of primary chest wall hemangiopericytoma in the lung after four years: a case report and review of the literature. Case Rep Oncol Med, 2014, 2014: 470268.
37. Yoshida M, Morita M, Kakimoto S, et al. Primary hemangiopericytoma of the trachea. Ann Thorac Surg, 2003, 76(3): 944-946.
38. 闵学文. 免疫组化技术在肺神经内分泌肿瘤病理诊断中的应用效果分析. 中国继续医学教育, 2017, 9(18): 69-70.
39. 张文玉, 黄勇, 申洪明, 等. 肺神经内分泌肿瘤的临床病理特征及影像学诊断. 实用肿瘤杂志, 2012, 27(1): 101-104.
40. Ramirez RA, Chauhan A, Gimenez J, et al. Management of pulmonary neuroendocrine tumors. Rev Endocr Metab Disord, 2017, 18(4): 433-442.
41. 杨雪梅, 陈伶俐, 李凤朝. 原发性气管主支气管肿瘤及瘤样病变 31 例分析. 南通大学学报(医学版), 2012, 32(4): 266-269.
42. 苏红, 李伟. 肺原发性上皮样平滑肌肉瘤一例. 解放军医药杂志, 2013, 25(7): 112-113.
43. 徐曙光, 应可净, 陈恩国, 等. 支气管镜下介入治疗原发性气道良性肿瘤 18 例临床分析. 现代实用医学, 2017, 29(5): 614-616.