Guo Xiao-Wan, Jia Xu-Dong, Ji A-Dan, Zhang Dan-Qing, Jia De-Zhao, Zhang Qi, Shao Qiu, Liu Yang
Department of Radiology, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China.
Departments of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang 050005, Hebei Province, China.
World J Clin Cases. 2022 Mar 16;10(8):2650-2656. doi: 10.12998/wjcc.v10.i8.2650.
It now seems that all pulmonary hamartomas (PHs) are large cystic-solid lesions that are difficult to diagnose. However, few cases of large cystic-solid PHs have been reported. The present case report presents a large cystic-solid PH and provides a literature review of the imaging features, formation mechanism and histopathological basis of PHs.
A 53-year-old woman with no clinical symptoms underwent a chest computed tomography (CT) examination at our hospital. Nonenhanced CT images revealed a large, flat tumor with multiple air-containing cysts in the left thoracic cavity and a cystic part confined to the medial side of the tumor; the solid part of the tumor showed abundant fat and lamellar soft tissue components. Multiple small blood vessels were detected in the solid part of the tumor on contrast-enhanced CT images. Given the large size of the lesion, the patient elected to undergo surgery. Histological examination revealed PH. A detailed review of the patient's CT imaging showed that the lesion had a small vascular pedicle to the left lower lobe, which was a clue to its lung tissue histological origin. According to immunohistochemical staining, the confined multiple air-containing cysts were caused by the entrapment of respiratory/alveolar epithelium.
This case shows the imaging manifestations of a large PH. Heightened awareness of its formation mechanism and histopathological basis may alert radiologists to consider this diagnosis in their daily workflow.
目前看来，所有肺错构瘤（PHs）均为大型囊实性病变，难以诊断。然而，大型囊实性PHs的病例报道较少。本病例报告展示了一例大型囊实性PH，并对PHs的影像学特征、形成机制及组织病理学基础进行文献综述。
一名53岁无症状女性在我院接受胸部计算机断层扫描（CT）检查。平扫CT图像显示左胸腔内有一个大型扁平肿瘤，伴有多个含气囊肿，且囊肿部分局限于肿瘤内侧；肿瘤实性部分显示有丰富脂肪和层状软组织成分。增强CT图像显示肿瘤实性部分有多个小血管。鉴于病变较大，患者选择接受手术。组织学检查显示为PH。对患者CT影像的详细回顾显示，病变有一个连接左下叶的小血管蒂，这是其肺组织组织学起源的线索。免疫组化染色显示，局限性多个含气囊肿是由呼吸/肺泡上皮陷入所致。
本病例展示了大型PH的影像学表现。提高对其形成机制和组织病理学基础的认识，可能会提醒放射科医生在日常工作流程中考虑这一诊断。
