Traweek T, Rotter A J, Swartz W, Azumi N
Sylvia Cowan Laboratory of Surgical Pathology, Division of Pathology, Duarte.
Cancer. 1990 Apr 15;65(8):1805-11. doi: 10.1002/1097-0142(19900415)65:8<1805::aid-cncr2820650823>3.0.co;2-v.
Neoplastic cavitary lesions are an unusual type of pulmonary metastases. The authors report two cases of cystic metastatic sarcoma of the lungs that illustrate the clinical, radiologic, and pathologic difficulties encountered in the diagnosis of these lesions. In one patient, multiple small, thin-walled cystic metastases from a lower leg leiomyosarcoma were the only manifestation of metastatic disease. The cystic lesions did not change over an 8-month period and a diagnosis of malignancy was not established until spontaneous pneumothorax, presumably due to rupture of the malignant blebs, prompted a thoracotomy. In the second patient, three thin-walled bullae developed after treatment of noncystic pulmonary metastases from a lower-leg synovial sarcoma. In both patients, the cystic lesions were not evident on chest radiographs, but were well visualized with computed tomography (CT), where they mimicked benign bullous disease. However, additional small cavitary lesions not seen with CT were present in resected pulmonary wedge specimens from both patients. A great degree of variability in the cellular composition of the cyst wall lining in both cases, and a lack of any solid neoplastic tissue masses in one case, led to histopathologic difficulties that required immunohistochemical studies for definitive diagnosis of the metastatic disease. These cases show that pulmonary bullae, even though thin-walled and benign-appearing on CT, may be a manifestation of pulmonary metastases. These lesions must therefore be surgically removed from patients in whom a curative resection of pulmonary metastases is warranted.
肿瘤性空洞性病变是一种不常见的肺转移类型。作者报告了两例肺囊性转移性肉瘤病例，阐述了诊断这些病变时遇到的临床、放射学和病理学难题。在一名患者中，来自小腿平滑肌肉瘤的多个小的薄壁囊性转移灶是转移性疾病的唯一表现。这些囊性病变在8个月内没有变化，直到自发性气胸（可能是由于恶性肺大疱破裂）促使进行开胸手术，才确诊为恶性肿瘤。在第二名患者中，小腿滑膜肉瘤的非囊性肺转移灶经治疗后出现了3个薄壁肺大疱。在两名患者中，胸部X线片上均未显示囊性病变，但计算机断层扫描（CT）清晰显示了这些病变，它们类似良性肺大疱疾病。然而，两名患者切除的肺楔形标本中均存在CT未显示的额外小空洞性病变。两例病例中囊肿壁内衬细胞组成差异很大，且其中一例缺乏任何实性肿瘤组织块，导致组织病理学诊断困难，需要进行免疫组化研究以明确转移性疾病的诊断。这些病例表明，肺大疱即使在CT上表现为薄壁且看似良性，也可能是肺转移的一种表现。因此，对于有必要进行肺转移瘤根治性切除的患者，必须手术切除这些病变。
