Barnoud Raphaëlle, Collardeau-Frachon Sophie, de la Roche Eric, Vasiljevic Alexandre, Thomson Vivien, Ranchère Dominique, Devouassoux Gilles, Devouassoux-Shisheboran Mojgan
Service d'anatomie et cytologie pathologiques, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France. raphaelle.barnoud@chu-lyon
Ann Pathol. 2010 Apr;30(2):139-42. doi: 10.1016/j.annpat.2010.01.004. Epub 2010 Apr 10.
Spontaneous pneumothorax may be one of the presenting manifestation of metastatic epithelioid sarcoma even if imaging does not show evident metastatic nodules. We report the case of a 24-year-old man presenting a bilateral spontaneous pneumothorax in association with an epithelioid sarcoma developed in the right foot. CT-scan revealed bilateral microcystic lesions with no evidence of metastatic disease. A left thoracoscopy and a pleurodesis were performed. Persistent air leakage led to a thoracotomy during which lung biopsies were carried out. Histopathological examination of the pulmonary biopsies revealed rare millimetric nodules, composed of very atypical epithelioid cells, growing along alveolar walls reminiscent of a bronchiolo-alveolar carcinoma. However, these cells and primary neoplastic cells of the foot tumour were morphologically and immunohistochemically similar and the atypical pulmonary cells were TTF1 negative. All these constatations allowed a diagnosis of pulmonary metastases of the epithelioid sarcoma. This very unusual case underlines that sarcomatous metastases may be a clinical and pathological pitfall.
自发性气胸可能是转移性上皮样肉瘤的首发表现之一，即便影像学检查未显示明显的转移结节。我们报告一例24岁男性病例，其出现双侧自发性气胸，同时右足部患有上皮样肉瘤。CT扫描显示双侧微囊性病变，未发现转移病灶迹象。进行了左侧胸腔镜检查及胸膜固定术。持续漏气导致行开胸手术，术中进行了肺活检。肺活检的组织病理学检查发现罕见的毫米级结节，由极不典型的上皮样细胞组成，沿肺泡壁生长，类似细支气管肺泡癌。然而，这些细胞与足部肿瘤的原发性肿瘤细胞在形态学和免疫组化方面相似，且非典型肺细胞TTF1呈阴性。所有这些发现确诊为上皮样肉瘤肺转移。这一非常罕见的病例强调肉瘤转移可能是临床和病理诊断中的陷阱。
