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年轻女性患者的散发性淋巴管平滑肌瘤病:一例报告并文献复习

Sporadic lymphangioleiomyomatosis in young female patient: A case report and review of the literature.

作者信息

Ayen Addisu Assfaw, Mihretu Dereje Desta, Getahun Amsalu Molla, Kassa Belayneh Dessie, Bezabih Fetene, Shumet Abebe

机构信息

Department of Internal Medicine, Debre Tabor University, Debre Tabor, Ethiopia.

Department of Internal Medicine, Pulmonology and Critical Care Unit, Bahir Dar University, Bahir Dar, Ethiopia.

出版信息

Int J Surg Case Rep. 2025 Oct;135:111913. doi: 10.1016/j.ijscr.2025.111913. Epub 2025 Sep 4.

DOI:10.1016/j.ijscr.2025.111913
PMID:40914090
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12447883/
Abstract

INTRODUCTION AND IMPORTANCE

Lymphangioleiomyomatosis (LAM) is a rare disorder of unknown cause which mostly affects young females and involving multi organ system with primarily involving lung.

PRESENTATION OF CASE

A 35 year's old female Ethiopian known hypertension patient from Debre Tabor, Ethiopia, Africa; presented with progressively increasing cough with blood tingled sputum of 1-2 Arabic coffee cup per day, progressively increasing exertional shortness of breath and easy fatigability seven years back. Hypertensive and desaturate to level of 88 % at atmospheric air. There was diffuse crackle over posterior 2/3 chest with decrease air entry over lower 1/3 chest bilaterally. There is obstructive airway pattern on Spirometry. Multiple bilateral diffuse uniformly distributed cystic lesions on chest CT scan and angiomyolipoma in the kidneys on abdominal ultrasound. She is on supportive treatment, Budesonide/ Formoterol and amlodipine for the diagnosis of sporadic LAM.

CLINICAL DISCUSSION

Sporadic LAM is a rare autosomal dominant disease affecting an estimated 3.4-7.8 per million individuals. While the pathophysiology remains unclear, LAM is thought to involve abnormal proliferation of smooth muscle-like cells, leading to cystic structures in axial lymphatics, lung cysts, and renal angiomyolipomas. Diagnosis is based on European Respiratory Society criteria, and management ranges from supportive care to definitive treatment depending on the patient's condition.

CONCLUSION

Sporadic LAM is a disorder affecting multiple organ systems, primarily the lungs, and presents with diverse clinical manifestations. Even though it is difficult to diagnosis without lung biopsy; sporadic LAM can be diagnosed with imaging with compatible history in resource limiting setup.

摘要

引言与重要性

淋巴管平滑肌瘤病(LAM)是一种病因不明的罕见疾病,主要影响年轻女性,累及多器官系统,以肺部受累为主。

病例介绍

一名35岁的埃塞俄比亚女性,来自非洲埃塞俄比亚德布雷塔博尔,患有高血压。七年前开始出现咳嗽逐渐加重,每天咳出1 - 2杯阿拉伯咖啡量的血痰,劳力性气短逐渐加重,且容易疲劳。血压高,在常压空气中血氧饱和度降至88%。双侧后胸2/3可闻及弥漫性湿啰音,双侧下胸1/3呼吸音减弱。肺功能检查显示为阻塞性气道模式。胸部CT扫描可见双侧多发弥漫性均匀分布的囊性病变,腹部超声显示肾脏有血管平滑肌脂肪瘤。她正在接受支持性治疗,使用布地奈德/福莫特罗和氨氯地平,以诊断散发性LAM。

临床讨论

散发性LAM是一种罕见的常染色体显性疾病,估计每百万人口中有3.4 - 7.8人受影响。虽然其病理生理学尚不清楚,但LAM被认为涉及平滑肌样细胞的异常增殖,导致轴向淋巴管、肺囊肿和肾血管平滑肌脂肪瘤中出现囊性结构。诊断基于欧洲呼吸学会的标准,治疗方法根据患者情况从支持性护理到确定性治疗不等。

结论

散发性LAM是一种累及多器官系统的疾病,主要是肺部,临床表现多样。尽管没有肺活检很难诊断;但在资源有限的情况下,结合影像学检查和相符的病史,散发性LAM也可被诊断。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/72bf/12447883/ec474b22f872/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/72bf/12447883/56af06c1c52d/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/72bf/12447883/ec474b22f872/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/72bf/12447883/56af06c1c52d/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/72bf/12447883/ec474b22f872/gr2.jpg

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