原发性肺血管肉瘤1例并文献复习

doi:10.6040/j.issn.1671-7554.0.2020.1533

摘要/Abstract

摘要： 目的分析原发性肺血管肉瘤的临床症状、影像学表现、病理特征、治疗方案及预后等要点,以提高临床诊疗能力。方法通过对1例原发性肺血管肉瘤患者临床诊断及治疗过程的分析,并结合相关文献总结复习原发性肺血管肉瘤的特点。以“lung angiosarcoma”“pulmonary angiosarcoma”“肺血管肉瘤”为关键词分别在PubMed、中国万方、中国知网数据库中检索,时间为1992年至2020年。结果患者,女,47岁,因“右侧胸痛10余天”于2020年3月28日入住山东大学齐鲁医院呼吸与危重症医学科,最终经CT引导下肺穿刺活检确诊为肺血管肉瘤。经过筛选,共纳入30篇资料完整(包括病史、诊断、治疗、预后)且患者最后确诊为原发性肺血管肉瘤的文献,共36例患者,其中男25例,女11例, 18~81岁,平均(52±17)岁。原发性肺血管肉瘤临床症状主要包括咳嗽、咯血、胸痛、呼吸困难等,影像学常见为单发或多发结节或肿块,伴或不伴磨玻璃样改变、胸腔积液、血管充盈缺损等。最终诊断依赖于组织病理及免疫组织化学检查。结论原发性肺血管肉瘤罕见,临床工作中应对咯血、胸痛、肺部结节/肿块等表现提高警惕,及早取得病理学诊断,避免误诊,正确治疗,延长生存期。

关键词: 原发性肺血管肉瘤, 临床症状, 影像学, 病理, 治疗

Abstract: Objective The clinical symptoms, imaging manifestations, pathological features, treatment and prognosis of primary pulmonary angiosarcoma were summarized in order to enhance the clinical diagnosis and treatment. Methods The clinical diagnosis and treatment of one case of pulmonary angiosarcoma were analyzed, and the characteristics of primary pulmonary angiosarcoma were reviewed. Key words including “lung angiosarcoma” and “pulmonary angiosarcoma” were searched in PubMed, China Wanfang and CNKI databases from 1992 to 2020. Results A 47 year-old female patient complaining of right chest pain for more than ten days was admitted to our department on March 28, 2020. Pulmonary angiosarcoma was diagnosed with CT-guided percutaneous lung biopsy. Altogether 30 studies with complete data(including history, diagnosis, treatment and prognosis)were retrieved, involving 36 patients, including 25 males and 11 females, aged 18-81 years, average(52±17)years. The clinical symptoms of primary pulmonary angiosarcoma included cough, hemoptysis, chest pain and dyspnea. The imaging characteristics were single or multiple nodules or masses with or without ground-glass opacity, pleural effusion and filling defects. The diagnosis depended on histopathology and immunohistochemistry. Conclusion Primary pulmonary angiosarcoma is a rare disease, with manifestations such as hemoptysis, chest pain, and pulmonary nodules/masses. Early diagnosis and appropriate treatment can prolong patients survival.

Key words: Primary pulmonary angiosarcoma, Clinical symptoms, Imaging, Pathology, Treatment

中图分类号:

R734.2

曾荣,吴金香,张锦涛,上官红,周生余,田甜,董亮. 原发性肺血管肉瘤1例并文献复习[J]. 山东大学学报 (医学版), 2021, 59(2): 19-25.

ZENG Rong, WU Jinxiang, ZHANG Jintao, SHANGGUAN Hong, ZHOU Shengyu, TIAN Tian, DONG Liang. Primary pulmonary angiosarcoma: a case report and literature review[J]. Journal of Shandong University (Health Sciences), 2021, 59(2): 19-25.

参考文献

[1] Young RJ, Brown NJ, Reed MW, et al. Angiosarcoma [J]. Lancet Oncol, 2010, 11(10): 983-991.
[2] Penel N, Marréaud S, Robin YM, et al. Angiosarcoma: State of the art and perspectives [J]. Crit Rev Oncol, 2011, 80(2): 257-263.
[3] Chen YB, Guo LC, Yang L, et al. Angiosarcoma of the lung: 2 cases report and literature reviewed [J]. Lung Cancer Amsterdam Neth, 2010, 70(3): 352-356.
[4] Ebi N, Yamamoto H, Sakai J, et al. Angiosarcoma of the heart presenting as fatal pulmonary hemorrhage [J]. Intern Med, 1997, 36(3): 191-193.
[5] 穆新林, 吴泽璇, 梁海杰, 等. 软组织血管肉瘤肺转移一例并文献复习[J]. 中华结核和呼吸杂志, 2016, 39(12): 948-952. MU Xinlin, WU Zexuan, LIANG Haijie, et al. Soft-tissue angiosarcoma with pulmonary metastases: case report and literature review [J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2016, 39(12): 948-952.
[6] Shirey L, Coombs D, Talwar A, et al. Pulmonary epithelioid angiosarcoma responsive to chemotherapy: a case report [J]. Radiol Case Rep, 2018, 13(2): 479-484.
[7] Miller R, Mudambi L, Vial MR, et al. Radiation-induced angiosarcoma as a cause of pleural effusion [J]. Am J Respir Crit Care Med, 2017, 196(4): e10-e11.
[8] Bosetti C, La Vecchia C, Lipworth L, et al. Occupational exposure to vinyl chloride and cancer risk: a review of the epidemiologic literature [J]. Eur J Cancer Prev, 2003, 12(5): 427-430.
[9] 戈霞晖, 朱晓萍, 张锦, 等. 肺原发性血管肉瘤1例[J]. 宁夏医学杂志, 2007, 29(6): 525.
[10] 李宁, 程齐俭, 李庆云,等. 肺血管肉瘤一例报道[J]. 上海交通大学学报(医学版), 2008, 28(12): 1609-1610.
[11] 张培芳, 罗志扬, 黄小军, 等. 原发性肺血管肉瘤一例[J]. 中华结核和呼吸杂志, 2009, 32(3): 230-232.
[12] Zhou Y, Wang WG, Zhang QH. Primary angiosarcoma of the lung: a case report [J]. The Chinese-German Journal of Clinical Oncology, 2012, 11(10): 609-611.
[13] 陈爱凤, 李柏颖, 沈晓强,等. 原发肺血管肉瘤一例[J]. 中华医学杂志, 2015, 95(2): 148-149.
[14] Pandit SA, Fiedler PN, Westcott JL. Primary angiosarcoma of the lung [J]. Ann Diagn Pathol, 2005, 9(5): 302-304.
[15] Eichner R, Schwendy S, Liebl F, et al. Two cases of primary pulmonary angiosarcoma as a rare cause of lung haemorrhage [J]. Pathology, 2011, 43(4): 386-389.
[16] Chen YB, Guo LC, Yang L, et al. Angiosarcoma of the lung: 2 cases report and literature reviewed [J]. Lung Cancer, 2010, 70(3): 352-356.
[17] Sheppard MN, Hansell DM, Du Bois RM, et al. Primary epithelioid angiosarcoma of the lung presenting as pulmonary hemorrhage [J]. Hum Pathol, 1997, 28(3): 383-385.
[18] Ozcelik C, Onat S, Yaldiz M, et al. Primary epithelioid angiosarcoma of the lung presenting as pulmonary hemorrhage [J]. Asian Cardiovasc Thorac Ann, 2006, 14(1): 69-71.
[19] Kakegawa S, Kawashima O, Ibe T, et al. A case of primary angiosarcoma of the lung presenting as a hemorrhagic bronchial tumor [J]. Ann Thorac Cardiovasc Surg, 2012, 18(4): 347-351.
[20] Obeso Carillo GA, García Fontán EM, Cañizares Carretero Má, et al. Primary pulmonary angiosarcoma, an exceptional neoplasm with a poor prognosis: reports of two cases and review of the literature [J]. Gen Thorac Cardiovasc Surg, 2013, 61(11): 643-647.
[21] Zhang Y, Huang XC, Peng CL, et al. Primary pulmonary epithelioid angiosarcoma: A case report and literature review [J]. J Cancer Res Ther, 2018, 14(Supplement): S533-S535.
[22] Piechuta A, Przybyowski T, Szokowska M, et al. Hemoptysis in a patient with multifocal primary pulmonary angiosarcoma [J]. Pneumonol Alergol Pol, 2016, 84(5): 283-289.
[23] Ren YH, Zhu M, Liu Y, et al. Primary pulmonary angiosarcoma: Three case reports and literature review [J]. Thorac Cancer, 2016, 7(5): 607-613.
[24] Ng FH, Yu SM, Wai OKH, et al. Primary epithelioid angiosarcoma of lung: radiologic and clinicopathologic correlation [J]. J Clin Imaging Sci, 2017, 7: 33. doi: 10.4103/jcis.jcis-71-16.
[25] Kuroda N, Hamaguchi N, Inoue K, et al. Application of immunocytochemistry to the diagnosis of primary epithelioid angiosarcoma of the lung [J]. Med Mol Morphol, 2009, 42(4): 250-253.
[26] Kojima K, Okamoto I, Ushijima S, et al. Successful treatment of primary pulmonary angiosarcoma [J]. Chest, 2003, 124(6): 2397-2400.
[27] Bohn OL, de León EAP, Lezama O, et al. Pulmonary artery sarcoma with angiosarcoma phenotype mimicking pleomorphic malignant fibrous histiocytoma: a case report [J]. Diagn Pathol, 2012, 7: 154. doi: 10.1186/1746-1596-7-154.
[28] Yang CF, Chen TW, Tseng GC, et al. Primary pulmonary epithelioid angiosarcoma presenting as a solitary pulmonary nodule on image [J]. Pathol Int, 2012, 62(6): 424-428.
[29] Grafino M, Alves P, de Almeida MM, et al. Angiosarcoma of the lung [J]. J Bras Pneumol, 2016, 42(1): 68-70.
[30] Shirey L, Coombs D, Talwar A, et al. Pulmonary epithelioid angiosarcoma responsive to chemotherapy: a case report [J]. Radiol Case Rep, 2018, 13(2): 479-484.
[31] Ma J, Zhang W, Huang Y, et al. Radiologic findings of primary pulmonary angiosarcoma: a case report [J]. Medicine(Madr), 2018, 97(25): e11105. doi: 10.1097/md.0000000000011105.
[32] Virarkar M, Tayyab S, Thampy R, et al. Primary pulmonary angiosarcoma: case reports and review of the literature [J]. Asian Cardiovasc Thorac Ann, 2019, 27(5): 347-352.
[33] 王巍, 李宁, 梁建琴, 等. 肺血管肉瘤的诊断与治疗: 附1例报告并文献复习[J]. 中国防痨杂志, 2010, 32(1): 45-48. WANG Wei, LI Ning, LIANG Jianqin, et al. Diagnosis and treatment of pulmonary angiosarcoma(1 case report and a literature review)[J]. The Journal of the Chinese Antituberculosis Association, 2010, 32(1): 45-48.
[34] Wan Musa WR, Abdulwakil Elraied MA, Phang KS, et al. Primary epithelioid angiosarcoma of the lung presenting as left-sided shoulder pain [J]. Ann Acad Med Singap, 2010, 39(8): 658-659.
[35] Atasoy Ç, Fitoz S, Yi(overg)it H, et al. Radiographic, CT, and MRI findings in primary pulmonary angiosarcoma [J]. Clin Imaging, 2001, 25(5): 337-340.
[36] Desmarais P, Laskine M, Caporuscio C. Primary pulmonary artery angiosarcoma mimicking pulmonary embolism in a 66-year-old man with dyspnea[J]. Can Med Assoc J, 2016, 188(17/18): 509-512.
[37] Faiek S, Tariq H, Upparapalli D, et al. Primary pulmonary epithelioid angiosarcoma: a rare case presentation of bilateral pneumothoraces [J]. Cureus, 2019, 11(12): e6514.
[38] 郭真真, 余梦菊, 段丽芬. 肺原发性血管肉瘤1例报道并文献复习[J].中外健康文摘, 2014,(19): 115-116.
[39] Yang X, Jiang J, Dong X, et al. Correlations between computed tomography and positron emission tomography/computed tomography findings and pathology in 6 cases of pulmonary epithelioid angiosarcoma [J]. Medicine(Baltimore), 2018, 97(35): e12107.
[40] Yogi A, Miyara T, Ogawa K, et al. Pulmonary metastases from angiosarcoma: a spectrum of CT findings [J]. Acta Radiol, 2016, 57(1): 41-46.
[41] 赵丹, 曲杨, 穆晶, 等. 肺血管肉瘤临床病理观察[J]. 诊断病理学杂志, 2012, 19(6): 450-453. ZHAO Dan, QU Yang, MU Jing, et al. Clinicopathological features of pulmonary angiosarcoma [J]. Chinese Journal of Diagnostic Pathology, 2012, 19(6): 450-453.
[42] Cao J, Wang J, He C, et al. Angiosarcoma: a review of diagnosis and current treatment [J]. Am J Cancer Res, 2019, 9(11): 2303-2313.
[43] Duck L, Baurain JF, Machiels JP. Treatment of a primary pulmonary angiosarcoma [J]. Chest, 2004, 126(1): 317-318.
[44] 夏瑜, 王宇翀, 薛春雨.血管肉瘤的研究进展[J]. 中国美容整形外科杂志, 2020, 31(4): 227-229.

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