Fontana D, Della Beffa V, Fusca M, Loddo F
Surgery B Unit, San Giovanni Bosco Hospital, Corso Chieri 184, 10132 Turin, Italy.
Minerva Chir. 2007 Feb;62(1):39-42.
We report a case of 40 year-old woman with left thoracic pain who was diagnosed as having a cystic mass located posteriorly at the basis of the left pleural cavity. The preoperative serum CA 19-9 level was increased (2 900 IU/mL). Further investigations did not find neoplastic lesions in the gastrointestinal tract. The intraoperative finding of an anomalous systemic arterial supply to the mass suggested the diagnosis of extralobar sequestration, confirmed at the histopathological examination. The association between pulmonary sequestration and increased tumor markers levels is overlooked in western literature, but it is often reported by many Japanese authors. This case report would underline the practical usefulness for preoperative diagnosis of pulmonary sequestration, when the CT-scan does not demonstrated an anomalous systemic vessel. The common embryogenic origin of both respiratory and digestive apparatus can explain the increased levels of tumor markers such as CA 19-9 and carcinoembryonic antigen in bronchogenic cyst, intestinal duplication and pulmonary sequestration.
我们报告一例40岁女性，因左侧胸痛就诊，诊断为左侧胸腔底部后方的囊性肿块。术前血清CA 19-9水平升高（2900 IU/mL）。进一步检查未发现胃肠道肿瘤性病变。术中发现肿块有异常体循环动脉供血，提示诊断为肺叶外型隔离症，组织病理学检查证实了这一诊断。在西方文献中，肺隔离症与肿瘤标志物水平升高之间的关联被忽视，但许多日本作者经常报道这种情况。本病例报告强调了在CT扫描未显示异常体循环血管时，肺隔离症术前诊断的实际实用性。呼吸和消化系统共同的胚胎发生起源可以解释支气管囊肿、肠重复畸形和肺隔离症中CA 19-9和癌胚抗原等肿瘤标志物水平升高的原因。
