Cerfolio R J, Allen M S, Nascimento A G, Deschamps C, Trastek V F, Miller D L, Pairolero P C
Section of General Thoracic Surgery and Division of Anatomic Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Ann Thorac Surg. 1999 Apr;67(4):933-6. doi: 10.1016/s0003-4975(99)00155-1.
Inflammatory pseudotumors of the lung are rare and often present a dilemma for the surgeon at time of operation. We reviewed our experience with patients who have this unusual pathology.
Between February 1946 and September 1993, 56,400 general thoracic surgical procedures were performed at the Mayo Clinic. Twenty-three patients (0.04%) had resection of an inflammatory pseudotumor of the lung. There were 12 women and 11 men. Median age was 47 years (range, 5 to 77 years). Six patients (26%) were less than 18 years old. All pathologic specimens were re-reviewed, and the diagnosis of inflammatory pseudotumor was confirmed. Eighteen patients (78%) were symptomatic which included cough in 12, weight loss in 4, fever in 4, and fatigue in 4. Four patients had prior incomplete resections performed elsewhere and underwent re-resection because of growth of residual pseudotumor. Wedge excision was performed in 7 patients, lobectomy in 6, pneumonectomy in 6, chest wall resection in 2, segmentectomy in 1, and bilobectomy in 1. Complete resection was accomplished in 18 patients (78%). Median tumor size was 4.0 cm (range, 1 to 15 cm). There were no operative deaths. Follow-up was complete in all patients and ranged from 3 to 27 years (median, 9 years).
Overall 5-year survival was 91%. Nineteen patients are currently alive. Cause of death in the remaining 4 patients was unrelated to pseudotumor. The pseudotumor recurred in 3 of the 5 patients who had incomplete resection; 2 have had subsequent complete excision with no evidence of recurrence 8 and 9 years later.
We conclude that inflammatory pseudotumors of the lung are rare. They often occur in children, can grow to a large size, and are often locally invasive, requiring significant pulmonary resection. Complete resection, when possible, is safe and leads to excellent survival. Pseudotumors, which recur, should be re-resected.
肺炎性假瘤罕见，在手术时常常给外科医生带来难题。我们回顾了我们治疗患有这种特殊病理疾病患者的经验。
1946年2月至1993年9月间，梅奥诊所进行了56400例普通胸外科手术。23例患者（0.04%）接受了肺炎性假瘤切除术。其中女性12例，男性11例。中位年龄为47岁（范围5至77岁）。6例患者（26%）年龄小于18岁。所有病理标本均重新检查，炎性假瘤诊断得以确认。18例患者（78%）有症状，其中咳嗽12例，体重减轻4例，发热4例，乏力4例。4例患者曾在其他地方接受过不完全切除，因残留假瘤生长而接受再次切除。7例患者行楔形切除术，6例行肺叶切除术，6例行全肺切除术，2例行胸壁切除术，1例行肺段切除术，1例行双叶切除术。18例患者（78%）完成了完整切除。肿瘤中位大小为4.0厘米（范围1至15厘米）。无手术死亡病例。所有患者均进行了完整随访，随访时间为3至27年（中位时间9年）。
总体5年生存率为91%。目前19例患者存活。其余4例患者的死亡原因与假瘤无关。5例不完全切除患者中有3例假瘤复发；其中2例随后进行了完整切除，8年和9年后均无复发迹象。
我们得出结论，肺炎性假瘤罕见。它们常发生于儿童，可长得很大，且常具有局部侵袭性，需要进行广泛的肺切除。可能的情况下，完整切除是安全的，且能带来良好的生存率。复发的假瘤应再次切除。
