Yamashita Takashi, Matsubayashi Yuta, Mochizuki Takahiro
Department of Thoracic Surgery, Iwata City Hospital, 512-3, Ohkubo, Iwata, Shizuoka, 438-8550, Japan.
Respir Med Case Rep. 2024 Jan 12;47:101981. doi: 10.1016/j.rmcr.2024.101981. eCollection 2024.
A 23-year-old female with a history of idiopathic epilepsy was found to have a right chest cavity shadow in a school health checkup 5 years before. CT revealed a thin-walled cavity lesion in the right middle lobe containing a ball-like mass, showing air crescent sign. After falling due to a seizure, she was transported by ambulance and admitted. CT revealed diffuse ground-glass opacities throughout the right lung field. Bronchoscopy revealed bloody bronchial alveolar lavage fluid. Due to the tumor hemorrhage, an elective simple right middle lobe resection was performed without complications. The initial immunohistochemical staining was negative for ALK using ALK1 clone; however, subsequent staining of ALK by D5F3 and 5A4 clone was positive. Immunostaining findings led to a diagnosis of inflammatory myofibroblastic tumor. The patient remains under regular observation and has experienced no recurrence over the 6-year postoperative period. This case contains two different points: the first is that a cavity lesion of inflammatory myofibroblastic tumor may cause traumatic bleeding and should be treated with caution; the second is that attention should be paid to differences in stainability among clones when diagnosing inflammatory myofibroblastic tumor.
一名23岁有特发性癫痫病史的女性，5年前在学校健康检查时发现右胸腔有阴影。CT显示右中叶有一个薄壁空洞性病变，内有一个球状肿块，呈空气新月征。因癫痫发作跌倒后，她被救护车送往医院并入院。CT显示右肺野弥漫性磨玻璃影。支气管镜检查显示支气管肺泡灌洗液呈血性。由于肿瘤出血，择期行单纯右中叶切除术，无并发症。最初使用ALK1克隆进行的ALK免疫组化染色为阴性；然而，随后用D5F3和5A4克隆进行的ALK染色为阳性。免疫染色结果导致诊断为炎性肌纤维母细胞瘤。患者仍在定期观察中，术后6年未复发。该病例有两个不同点：一是炎性肌纤维母细胞瘤的空洞性病变可能导致外伤性出血，应谨慎处理；二是在诊断炎性肌纤维母细胞瘤时应注意各克隆间染色性的差异。
