背景:肺母细胞瘤是一种极其罕见且高度侵袭性的肿瘤。仅报道了几百例肺母细胞瘤。在其他情况下,明确的诊断通常是通过手术切除。由于肺母细胞瘤组织学的多样性,术前组织病理学取样在诊断中的应用价值有限。并且没有文献表明第一次活检是用医用胸腔镜检查进行诊断的。
方法:一名65岁男子因胸腔积液和肺部肿块来我院就诊。
方法:患者最初通过内科胸腔镜活检诊断为去分化软骨肉瘤,但通过双叶切除术最终诊断为肺母细胞瘤。
方法:医用胸腔镜检查,和电视辅助胸腔镜手术(双叶切除术),然后辅助化疗。
结果:手术切除肿瘤后,辅助化疗已进行了5个周期,间隔3周,并且在术后4个月进行的计算机断层扫描随访中没有复发的证据。
结论:内科胸腔镜检查对诊断不确定的胸腔积液有用;然而,确认罕见恶性肿瘤时需要小心,如肺母细胞瘤。虽然手术切除是首选的治疗方法,如果存在胸膜转移,则需要适当的辅助化疗以改善预后。
BACKGROUND: Pulmonary blastoma is an extremely rare and highly aggressive tumor. Only a few hundred cases of pulmonary blastoma have been reported. In other cases, a definitive diagnosis is often made through surgical resection. The use of preoperative histopathological sampling in diagnosing was of limited value because of the variety of pulmonary blastoma histology. And there was no literature that the first biopsy was attempted with medical thoracoscopy for diagnosis.
METHODS: A 65-year-old man presented to our hospital with pleural effusion and lung mass.
METHODS: The patient was initially diagnosed with dedifferentiated chondrosarcoma by medical thoracoscopic biopsy but the final diagnosis was pulmonary blastoma through bilobectomy.
METHODS: Medical thoracoscopy, and video-assisted thoracoscopic surgery (bilobectomy) followed by adjuvant chemotherapy.
RESULTS: After surgical resection of the tumor, adjuvant chemotherapy has been performed 5 cycles at 3 weeks intervals, and there was no evidence of recurrence on follow-up computed tomography performed 4 months after surgery.
CONCLUSIONS: Medical thoracoscopy is useful for the diagnosis of indeterminate pleural effusion; however, caution is needed when confirming rare malignancies, such as pulmonary blastoma. Although surgical resection is the treatment of choice, appropriate adjuvant chemotherapy to improve the prognosis may be necessary if there is pleural metastasis.