目的:探索临床,成像,孤立性肺毛细血管瘤(SPCH)的病理特征和鉴别诊断。
方法:收集32例SPCH病例,与文献综述。
结果:这项研究包括13名男性和19名女性,男女比例为1:1.5。年龄范围为26至70岁(中位年龄为43岁)。所有患者在就诊时无症状。在胸部计算机断层扫描(CT)期间偶然发现了肺结节。影像学特征包括21例部分实性结节(PSN),7例磨玻璃结节(GGN),实性结节(SN)4例。11例位于左肺基底下段,11例右肺基底下段,右肺上眼前段6例,右肺中外侧段4例。肺的下基底段累及22例(每肺11例)(22/32,68%)。肿瘤范围为6至18mm(平均10mm)。宏观上,16例有明确的界限,虽然16个病例的界限不清楚,和灰红色或深棕色的切割表面。术中冰冻切片27例,诊断为SPCH12例,肺炎或炎性病变15例。微观上,结节由密集增殖和扩张的毛细血管组成。毛细血管壁衬有单层扁平的内皮细胞,没有非典型特征。塌陷的肺泡间隔被大量毛细血管取代。所有病例均表现为毛细血管增生,扩散到小静脉/动脉和支气管壁,3例表现为扩张的毛细血管突入细支气管腔,呈息肉样结构。26例(26/32,81%)显示增生的毛细血管越过小叶间隔。26例(26/32,81%)病灶周围区小肌动脉内膜不规则增厚,增厚的内膜是细胞或纤维。在27例(27/32,84%)中,病变位于胸膜下,6例胸膜。
结论:SPCH是一种罕见的肺良性肿瘤,多发生在肺下基底段,以女性为主。它通常在CT上表现为毛玻璃结节,与早期肺癌非常相似。准确的诊断需要放射科医师的协作,外科医生,和病理学家。SPCH应作为肺小结节的重要鉴别诊断。
OBJECTIVE: To explore the clinical, imaging, pathologic characteristics and differential diagnosis of solitary pulmonary capillary hemangioma (SPCH).
METHODS: Thirty two cases of SPCH were collected and studied, with literature review.
RESULTS: This study included 13 males and 19 females, with a male-to-female ratio of 1:1.5. The age ranged from 26 to 70 years (median age of 43 years). All patients were asymptomatic at presentation. Lung nodules were incidentally discovered during chest computed tomography (CT). Imaging features included 21 cases with partial solid nodules (PSN), 7 cases with ground-glass nodules (GGN), and 4 cases with solid nodules (SN). Eleven cases were in the left lung lower basal segment, 11 cases in the right lung lower basal segment, 6 cases in the right lung upper anterior segment, and 4 cases in the right lung middle lateral segment. The lower basal segments of the lungs were involved in 22 (11 in each lung) cases (22/32, 68 %). The tumors ranged from 6 to 18 mm (average 10 mm). Macroscopically, 16 cases had clear boundaries, while 16 cases had unclear boundaries, and gray-red or dark brown on cut surfaces. Intraoperative frozen section was performed in 27 cases, with diagnosis of SPCH in 12 and pneumonia or inflammatory lesion in 15. Microscopically, the nodules were composed of densely proliferated and dilated capillaries. The capillary walls were lined with a single layer of flat endothelial cells, without atypical features. Collapsed alveolar septa were replaced by a large number of capillaries. All cases showed proliferating capillaries spreading into the walls of small veins/arteries and bronchi, with 3 cases showing dilated capillaries protruding into the bronchiolar lumens as polyp-like structures. Twenty-six cases (26/32, 81 %) showed proliferating capillaries passed over the interlobular septa. Twenty-six cases (26/32, 81 %) showed irregular intimal thickening of small muscular arteries in the peripheral areas of the lesions, with the thickened intima being cellular or fibrous. In twenty-seven cases (27/32, 84 %) the lesions were located in the subpleura, with 6 cases involving the pleura.
CONCLUSIONS: SPCH is a rare benign lung tumor that mostly occurs in the lung lower basal segments with predominance in females. It usually appears as a ground-glass nodule on CT and is very similar to early-stage lung cancer. Accurate diagnosis requires collaboration of radiologists, surgeons, and pathologists. SPCH should be regarded as an important differential diagnosis of small incidental lung nodules.