Nakajima Yuki, Koizumi Kiyoshi, Haraguchi Shuji, Kawamoto Masashi, Kubokura Hirotoshi, Okada Daisuke, Yoshino Naoyuki, Kinoshita Hiroyasu, Takeuchi Shingo, Fukuda Yuh, Shimizu Kazuo
Division of Thoracic Surgery, Department of Surgery, Nippon Medical School, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2010 Apr;16(2):113-7.
We report a glomus tumor of the bronchus that showed invasion of the neural area and extrabronchial extension without significant histological malignancy. The patient was a male in his late 30s with the chief complaint being hemosputum. CT revealed a nodal shadow 15 mm in diameter in the right bronchus intermedius. An irregularly protruding lesion on the tumor surface was observed by bronchoscopy immediately under the second carina in the right truncus intermedius, but could not be diagnosed because of bleeding. Sleeve lobectomy of the right upper lobe was performed, since carcinoid tumor was suspected in open chest biopsy and intraoperative frozen section diagnosis. A solid growth of spherical and cubic uniform cells with a clear eosinophilic cytoplasm and spherical nuclei was observed. Immunohistochemistry was positive for α-smooth muscle actin and type IV collagen, weakly positive for synaptophysin, and negative for keratin, neural cell adhesion molecule, chromogranin A, desmin, CD34, and S100, leading to a diagnosis of glomus tumor. Neuroinvasion and extrabronchial tumor extension were observed, but an atypical cytology, bleeding, or necrosis was found histologically. This is the first description of infiltrative glomus tumor of the bronchus.
我们报告一例支气管球瘤，该肿瘤显示侵犯神经区域并向支气管外扩展，但组织学上无明显恶性特征。患者为一名30多岁的男性，主要症状为咯血。CT显示右中间支气管有一个直径15mm的结节阴影。在右中间支气管第二隆突下方立即通过支气管镜观察到肿瘤表面有一个不规则突出的病变，但由于出血无法诊断。由于在开胸活检和术中冰冻切片诊断中怀疑为类癌肿瘤，故行右上叶袖状肺叶切除术。观察到由球形和立方形均匀细胞组成的实性生长，细胞质嗜酸性明显，细胞核呈球形。免疫组化显示α-平滑肌肌动蛋白和IV型胶原呈阳性，突触素呈弱阳性，角蛋白、神经细胞黏附分子、嗜铬粒蛋白A、结蛋白、CD34和S100呈阴性，从而诊断为球瘤。观察到神经侵犯和支气管外肿瘤扩展，但在组织学上未发现非典型细胞学、出血或坏死。这是支气管浸润性球瘤的首次描述。
