Saitou Miwako, Niitsuma Katsunao
Department of Internal Medicine, Aizu General Hospital, 10-75, Shiromae, Aizuwakamatsu-shi, Fukushima 965-0803 Japan.
Kekkaku. 2009 Jul;84(7):531-4.
A 76-year-old man with a dry cough visited our hospital in June 2006. A chest X-ray showed opacification of the left hemithorax and CT demonstrated a soft tissue mass with pleural calcification. At first, we considered he had acute bronchitis with an old tuberculous pyothorax. But, his condition deteriorated with the additional complaint of a left chest pain and shortness of breath in September 2006. Consequently, he was admitted to our hospital. CT demonstrated that the soft tissue mass was growing and was invading the left rib and submammary tissue. Neither CT nor sonographically guided fine needle biopsies and cytological examinations were helpful in diagnosing this disease. He died of respiratory failure 2 months after admission. Autopsy revealed pyothorax and a hemorrhagic tumor from the left side of the thoracic cavity to the chest wall. Microscopic examination showed that atypical cells had proliferated and formed vascular structures, which were stained positively with anti-factor VIII antibody. Finally, the diagnosis was made of pyothorax-associated pleural Angiosarcoma. Angiosarcoma is rare and difficult to diagnosis, however, we have to keep in mind the presence of disease pyothorax-associated pleural angiosarcoma.
一名76岁干咳男性于2006年6月就诊于我院。胸部X线显示左半胸混浊，CT显示有一伴有胸膜钙化的软组织肿块。起初，我们认为他患有急性支气管炎合并陈旧性结核性脓胸。但是，2006年9月他出现了左胸痛和气短等新症状，病情恶化。因此，他入住我院。CT显示软组织肿块在增大，并侵犯左侧肋骨及乳房下组织。CT引导下或超声引导下的细针穿刺活检及细胞学检查均无助于该病的诊断。入院2个月后，他死于呼吸衰竭。尸检发现脓胸以及从胸腔左侧至胸壁的出血性肿瘤。显微镜检查显示非典型细胞增生并形成血管结构，抗因子VIII抗体染色呈阳性。最终诊断为脓胸相关性胸膜血管肉瘤。血管肉瘤罕见且难以诊断，然而，我们必须牢记脓胸相关性胸膜血管肉瘤这种疾病的存在。
