摘要
目的 通过临床病例分析 ,了解肺内神经鞘瘤的临床和影像表现 ,提高鉴别诊断能力。方法 对 1979年 1月～ 2 0 0 1年 10月期间收治的 7例肺内神经鞘瘤的临床、影像学表现及诊断依据进行分析。结果 主要症状 :小量咯血、咳嗽、发热、气促、胸痛。纤维支气管镜检查 :支气管腔内见新生物 3例 ,外压性狭窄 2例。影像表现 :左总支气管腔内见结节阻塞 2例 ;肺内单发肿块 4例 ;多发肿块1例 (2个病灶 )。肿块边缘光整 3个 (良性 2个 ,恶性 1个 ) ,毛糙 3个 (恶性 )。CT增强扫描 ,表现为网格样强化 1个 (良性 )、周边强化 1个 (恶性 )、不均质强化 4个 (良性 1个 ,恶性 3个 )。伴支气管和肋骨受压 2例。恶性神经鞘瘤中见胸膜浸润伴胸液 1例、血管受侵 2例。结论 肺内神经鞘瘤罕见 ,临床及影像学表现缺乏特异性。肿瘤大小和密度对良恶性鉴别无特征意义 ,肿瘤边界不光整提示恶性可能 。
Objective To analyze the clinical and radiological manifestations of primary pulmonary schwannoma in order to improve the diagnosis of this rare disease Methods Seven cases of primary pulmonary schwannoma which was confirmed by pathology of surgical specimens were retrospectively analyzed Results Three cases were benign (1 of pulmonary parenchymal origin and 2 of bronchial origin) and 4 were malignant (3 of pulmonary parenchymal origin and 1 of bronchial origin) There were four male and three female patients,age ranging from 31 to 74 years All the 7 cases had chest X ray films and 6 cases had chest CT examinations The major complains included slight hemoptysis,cough,fever, chest pain and shortness of breath Bronchoscopy showed bronchial tumors in 3 cases and partial stenosis of bronchus in 2 cases Radiology showed nodules in the left main bronchus in 2 cases Solitary mass was found in 4 cases and multiple masses (2 lesions) were found in one patient The margin of the lesions was smooth in 3 cases (one malignant and two benign) and irregular in another three cases (all malignant).Chest CT showed reticular enhancement in one case (benign),heterogeneous enhancement in 4 cases (3 malignant and 1 benign),and peripheral enhancement with a large central hypodense area in one case (malignant) Compression of the trachea and ribs was prominent in 2 patients Pleural effusion and blood vessel infiltration were evident in 3 patients with malignant schwannoma Conclusion Primary pulmonary schwannoma is rare The symptoms and CT manifestations are nonspecific The size and the density of the tumor are not helpful in differentiating malignant schwannoma from the benign one Marginal irregularity and invasion of adjacent structures are suggestive of malignancy
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2003年第1期3-6,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
