LuLu Xu, Jian Shu
Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Medicine (Baltimore). 2019 Dec;98(51):e18416. doi: 10.1097/MD.0000000000018416.
Pulmonary spindle cell carcinoma (PSCC) is a rare subset of pulmonary sarcomatoid carcinoma. PSCC is aggressive and has a poor prognosis. Pulmonary sclerosing pneumocytoma (PSP) is an asymptomatic slow-growing benign tumor, which usually occurs in middle-aged women.
Herein, we report a case of solitary PSCC, occurring concomitantly with PSP in a 74-year-old woman. The patient visited our institution with productive purulent cough, dyspnea after activity, and hemoptysis. Enhanced computed tomography revealed an inhomogeneous enhanced mass with central low-attenuation in the right upper lobe (RUL). The mass located in the right lower lobe (RLL) exhibited homogeneous enhancement.
These lesions were subsequently diagnosed as PSCC in the RUL and PSP in the RLL, following postoperative pathological examination.
We performed lobectomy for the RUL and wedge resection for the RLL in one procedure.
The patient did not experience complications after surgery. No radiological evidence of recurrence was observed on follow-up computed tomography performed within 7 months after the procedure.
This case fully reflects the importance of the differential preoperative diagnosis of benign and malignant solitary pulmonary nodules. However, a rare and aggressive malignant tumor may have imaging features typical of a lung abscess, which should be treated carefully.
肺梭形细胞癌（PSCC）是肺肉瘤样癌的一种罕见亚型。PSCC具有侵袭性，预后较差。肺硬化性肺细胞瘤（PSP）是一种无症状、生长缓慢的良性肿瘤，通常发生于中年女性。
在此，我们报告一例74岁女性患者，其孤立性PSCC与PSP同时存在。该患者因脓性咳痰、活动后呼吸困难及咯血前来我院就诊。增强计算机断层扫描显示右上叶（RUL）有一个不均匀强化的肿块，中心呈低密度。位于右下叶（RLL）的肿块呈均匀强化。
术后病理检查后，这些病变随后被诊断为RUL的PSCC和RLL的PSP。
我们在一次手术中对RUL进行了肺叶切除术，对RLL进行了楔形切除术。
患者术后未出现并发症。在术后7个月内进行的随访计算机断层扫描中，未观察到复发的影像学证据。
该病例充分体现了术前鉴别诊断孤立性肺结节良恶性的重要性。然而，一种罕见且侵袭性的恶性肿瘤可能具有典型肺脓肿的影像学特征，对此应谨慎处理。
