Ito Nao, Iizuka Shuhei, Sasaki Kanji, Otsuki Yoshiro, Nakamura Toru
Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan.
Department of Orthopedic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan.
Surg Case Rep. 2023 Jan 26;9(1):10. doi: 10.1186/s40792-023-01591-1.
A solitary pulmonary nodule (SPN) poses a diagnostic challenge, which includes both a benign and malignant etiology. A size enlargement often indicates malignancy. We herein describe a case of a solitary pulmonary metastasis from a leiomyosarcoma that regressed transiently during follow-up.
A 47-year-old woman presented with an SPN detected by follow-up computed tomography 7 years after surgery for a left forearm high-grade leiomyosarcoma. The nodule regressed spontaneously after an additional 6 months, and therefore, an inflammatory change was the most likely diagnosis at that time. However, the nodule enlarged again over the next 5 years. The growth rate led us to suspect a malignancy. A trans-bronchial biopsy was undiagnostic and a video-assisted thoracic surgery was planned. She underwent a wedge resection of the right lung, and a histopathological examination found it was a metastatic leiomyosarcoma.
A pulmonary metastasis from a leiomyosarcoma could emerge as an SPN and reveal a subsequent transient size reduction. An SPN in patients even with a remote history of a soft tissue tumor should raise the possibility of metastasis, and periodic follow-up is essential even after the size reduction.
孤立性肺结节（SPN）带来了诊断挑战，其病因包括良性和恶性。大小增大通常提示恶性。我们在此描述一例平滑肌肉瘤的孤立性肺转移瘤，在随访期间出现短暂退缩。
一名47岁女性，在左前臂高级别平滑肌肉瘤手术后7年，随访计算机断层扫描发现一个SPN。6个月后该结节自发退缩，因此当时最可能的诊断是炎症改变。然而，在接下来的5年里结节再次增大。其生长速度使我们怀疑为恶性。经支气管活检未明确诊断，遂计划行电视辅助胸腔镜手术。她接受了右肺楔形切除术，组织病理学检查发现是转移性平滑肌肉瘤。
平滑肌肉瘤的肺转移可表现为SPN，并随后出现大小短暂缩小。即使有软组织肿瘤既往史的患者出现SPN，也应提高转移的可能性，即使在大小缩小后定期随访也至关重要。
