Flieder D B, Moran C A, Travis W D, Koss M N, Mark E J
Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, DC 20306, USA.
Hum Pathol. 1998 Dec;29(12):1495-503. doi: 10.1016/s0046-8177(98)90021-1.
The clinical and pathological features of nine cases of pleuro-pulmonary endometriosis and the first case of pulmonary ectopic deciduosis are presented. The patients were all women between the ages of 27 and 74 years (median, 36 years) who presented with symptoms of catamenial pleural pain, shortness of breath, hemoptysis, or radiographically detected lung masses. Clinically, six patients were multiparous, one patient had pelvic endometriosis, and four patients had undergone prior pelvic surgical procedures, including dilatation and curettage. Radiographically, eight patients had pulmonary infiltrates or nodules, and four patients had pneumothorax. Three cases involved the visceral pleura and one case the parietal pleura. The other six cases, including the single case of ectopic deciduosis, involved the lung parenchyma. Histologically, the single or multifocal lesions were well circumscribed or infiltrative, nodular, cystic, or nodulo-cystic, and showed the characteristic features of proliferative or secretory endometrium with numerous mullerian metaplastic changes. Mucin stains were negative in five cases of endometriosis and in the single case of ectopic deciduosis. Immunohistochemical studies were performed in these same six cases using antibodies to epithelial, mesenchymal, vascular, and neuroendocrine markers. The glandular epithelium was decorated with antibodies to pan-cytokeratin, CK7, BER-EP4, ER, and PR, whereas the stromal cells showed positive staining for vimentin, actin, smooth muscle actin, desmin, ER, and PR. Follow-up information obtained in seven patients showed all women without recurrences after 1 to 20 years. The current study highlights the importance of recognizing intrathoracic endometriosis and ectopic deciduosis and properly assessing small biopsy specimens to avoid a misdiagnosis of malignancy.
本文报告了9例胸膜-肺子宫内膜异位症及首例肺异位蜕膜病的临床和病理特征。患者均为27至74岁的女性（中位年龄36岁），表现为经期性胸膜疼痛、气短、咯血或影像学检查发现肺部肿块等症状。临床上，6例为经产妇，1例有盆腔子宫内膜异位症，4例曾接受过盆腔外科手术，包括刮宫术。影像学检查显示，8例患者有肺部浸润或结节，4例有气胸。3例累及脏层胸膜，1例累及壁层胸膜。其他6例，包括单例异位蜕膜病，累及肺实质。组织学上，单个或多灶性病变边界清晰或呈浸润性、结节状、囊性或结节-囊性，表现为增殖期或分泌期子宫内膜的特征，并伴有大量苗勒氏化生改变。5例子宫内膜异位症及单例异位蜕膜病的黏液染色均为阴性。对这6例患者进行了免疫组织化学研究，使用了针对上皮、间充质、血管和神经内分泌标志物的抗体。腺上皮细胞表达泛细胞角蛋白、CK7、BER-EP4、雌激素受体（ER）和孕激素受体（PR）抗体，而基质细胞波形蛋白、肌动蛋白、平滑肌肌动蛋白、结蛋白、ER和PR染色呈阳性。7例患者的随访信息显示，所有女性在1至20年后均无复发。本研究强调了认识胸内子宫内膜异位症和异位蜕膜病以及正确评估小活检标本以避免误诊为恶性肿瘤的重要性。
