Mizuno Yoshimasa, Iwata Hisashi, Shirahashi Koyo, Hirose Yoshinobu, Takemura Hirofumi
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
Gen Thorac Cardiovasc Surg. 2011 Apr;59(4):297-300. doi: 10.1007/s11748-010-0651-6. Epub 2011 Apr 12.
We report two cases of pulmonary epithelioid hemangioendothelioma (PEH). Both patients presented with multiple bilateral pulmonary nodules, <10 mm diameter, on computed tomography (CT). Multiple pulmonary metastases were considered, but no primary malignant lesion was detected by other imaging modalities including (18)F-fl uorodeoxyglucose positron emission tomography ((18)F-FDG-PET)/CT. Moreover, the nodules did not show increased uptake of (18)F-FDG. We performed pulmonary wedge resections by video-assisted thoracoscopic surgery (VATS). Histological and immunohistochemical analysis revealed PEH in both. Positivity for the monoclonal antibody MIB-1 in the tumor cells was 5% in the fi rst case and 5%-10% in the second case. Slow tumor progression was detected with CT in the second case. Although (18)F-FDG PET/CT is effective for screening other malignant lesions, it does not appear to be of direct use in the diagnosis and surgical planning of PEH. Pathological diagnosis by VATS is the most effective method. MIB-1 positivity should be analyzed as to whether it is a prognostic factor of PEH.
我们报告两例肺上皮样血管内皮瘤（PEH）。两名患者在计算机断层扫描（CT）上均表现为双侧多发肺结节，直径<10毫米。考虑存在多发肺转移，但包括（18）F-氟脱氧葡萄糖正电子发射断层扫描（（18）F-FDG-PET）/CT在内的其他影像学检查均未发现原发性恶性病变。此外，这些结节未显示（18）F-FDG摄取增加。我们通过电视辅助胸腔镜手术（VATS）进行了肺楔形切除术。组织学和免疫组化分析显示两例均为PEH。第一例肿瘤细胞中针对单克隆抗体MIB-1的阳性率为5%，第二例为5%-10%。在第二例中通过CT检测到肿瘤进展缓慢。尽管（18）F-FDG PET/CT对筛查其他恶性病变有效，但它似乎对PEH的诊断和手术规划没有直接用途。通过VATS进行病理诊断是最有效的方法。应分析MIB-1阳性是否为PEH的预后因素。
