实性肺胎盘样变形1例及文献复习

doi:10.19723/j.issn.1671-167X.2023.02.023

摘要/Abstract

摘要：

肺胎盘样变形(placental transmogrification of the lung, PTL)是一种非常罕见的良性肺部病变, 国内外文献报道仅40多例, 影像和组织形态学表现多样, 多为单侧囊性病变, 少数为实性结节。由于实性PTL极为罕见, 大多数病理医生和外科医生对其认识不足。本研究报道1例位于前纵隔以实性结节为特点的PTL, 并结合文献复习, 以提高广大医生对这一罕见病的认识。患者为男性, 52岁, 无吸烟史, 无明显临床症状。体检胸部CT发现左肺下叶后基底段脊柱旁有一个圆形低密度灶, 最大径约2.9 cm, 于胸腔镜下行肺段楔形切除送检。大体形态: 肺膜下肺实质内类圆形结节, 大小3.0 cm×3.0 cm×1.6 cm, 切面灰白, 海绵状, 质软。镜下可见结节由乳头状结构组成, 低倍镜下形似胎盘绒毛。乳头轴心间质水肿, 粉染无定形物及钙盐沉积, 少量淋巴细胞浸润, 毛细血管充血明显; 其间可见形态温和的圆形细胞增生、聚集, 细胞质浅染或空泡状, 细胞核圆形或卵圆形, 与脂肪细胞移行过渡, 免疫组织化学染色CD10阳性; 乳头表面被覆单层立方上皮, 无异型性, 无核分裂象。术后患者随访1年, 无复发及不适。该病的发病机制目前尚不清楚, 有错构瘤、肺气肿变异和间质细胞克隆性增生等多种假说。结合本病例并在文献复习的基础上, 我们推测PTL的发病机制可能为, 肺泡间隔内不成熟间质细胞增生并向各类间叶细胞分化, 随着病变的不断发展, 因阻塞活瓣效应或增生组织的牵拉作用引起继发性囊性变, 最终出现典型的单侧囊性结节。外科手术是PTL确诊和治疗的唯一选择, 临床医生可依据临床表现、PTL发生的部位及范围制定个体化手术方案, 在完整切除病灶的同时尽量保留周围正常肺组织, 术后预后良好。

关键词: 肺疾病, 实性肺胎盘样变形, 鉴别诊断, 临床病理学

Abstract:

Placental transmogrification of the lung (PTL) is a very rare benign lung lesion. There are only about 40 cases reported in the literature. The imaging and histological features of PTL cases in the publication are various, most of which are cystic and a few of which are solid. Being extremely rare, the solid PTL is unknown to major pathologists and surgeons. We reported a case of solid PTL in the anterior mediastinum. The patient was a 52-year-old male with no history of smoking and without symptoms. During physical examination, chest CT revealed a circular low-density lesion with a maximum diameter of 2.9 cm beside the spine in the posterior basal segment of the left lower lobe of the lung. The wedge resection was performed by video-assisted thoracoscopy. Grossly, a round nodule was located underneath the visceral pleura. It was about 3.0 cm×3.0 cm×1.6 cm and the cut surface was grey-red, soft and spongy. Microscopically, the nodule was constituted of papillare, which resembled placental villi at low magnification. The axis of papillae was edema, in which some mild round cells with clear cytoplasm and CD10 positive staining aggregated and transitioned to immature adipocytes and amorphous pink materials deposited with a few of inflammatory cells infiltration. The surface of papillae was covered with disconti-nuous alveolar epithelium. Combined with the typical morphology and immunohistochemical characteristics of CD10 positive, the diagnosis was PTL. The patient was followed up for 1 year without recurrence and discomfort. So far, the pathogenesis of PTL is unclear. The major hypotheses include hamartoma, variant of emphysema and clonal hyperplasia of stromal cells. Based on the study of our case and publication, we speculate that the hyperplasia of stromal cells located in the alveolar septa might be the first step to form the solid PTL. With the progression of the disease, a typical unilateral cystic nodule develops as a result of secondary cystic degeneration due to the occlusive valve effect. Surgery is the only option for diagnosis and treatment of PTL. The clinician should make an individualized operation plan according to the clinical manifestations, location and scope of the lesion, and preserve the surrounding normal lung tissue as much as possible while completely removing the lesion. There is a favorable prognosis.

Key words: Lung disease, Solid placental transmogrification of the lung, Differential diagnosis, Clinical pathology

中图分类号:

R734.2

哈雪梅,姚永正,孙莉华,辛春杨,熊焰. 实性肺胎盘样变形1例及文献复习[J]. 北京大学学报（医学版）, 2023, 55(2): 357-361.

Xue-mei HA,Yong-zheng YAO,Li-hua SUN,Chun-yang XIN,Yan XIONG. Solid placental transmogrification of the lung: A case report and literature review[J]. Journal of Peking University (Health Sciences), 2023, 55(2): 357-361.

图/表 4

图1

图2

图3

图4

参考文献 20

1	McChesney T . Placental transmogrification of the lung: A unique case with remarkable histopathologic features[J]. Lab Invest, 1979, 40, 245- 246.
2	Mark EJ , Muller KM , McChesney T , et al. Placentoid bullous lesion of the lung[J]. Hum Pathol, 1995, 26 (1): 74- 79. doi: 10.1016/0046-8177(95)90117-5
3	Saito Y , Ikeya T , Hoshi E , et al. Placental transmogrification of the lung presenting as a small solitary nodule[J]. Ann Thorac Surg, 2009, 87 (3): 950- 952. doi: 10.1016/j.athoracsur.2008.07.063
4	Ma DJ , Liu HS , Li SQ , et al. Placental transmogrification of the lung: Case report and systematic review of the literature[J]. Medicine (Baltimore), 2017, 96 (35): e7733. doi: 10.1097/MD.0000000000007733
5	Yang M , Zhang XT , Liu XF , et al. Placental transmogrification of the lung presenting as a peripheral solitary nodule in a male with the history of trauma: A case report[J]. Medicine (Baltimore), 2018, 97 (18): e0661. doi: 10.1097/MD.0000000000010661
6	Foschini G , Rodríguez CM , Rubio MM , et al. Placental transmogrification of the lung[J]. Arch Bronconeumol, 2022, 58 (5): 433. doi: 10.1016/j.arbres.2021.04.004
7	Kim JW , Park IH , Kwon W , et al. Placental transmogrification of the lung[J]. Korean J Radiol, 2013, 14 (6): 977- 980. doi: 10.3348/kjr.2013.14.6.977
8	Cavazza A , Lantuejoul S , Sartori G , et al. Placental transmogrification of the lung: Clinicopathologic, immunohistochemical and molecular study of two cases, with particular emphasis on the interstitial clear cells[J]. Hum Pathol, 2004, 35 (4): 517- 521. doi: 10.1016/j.humpath.2003.10.023
9	Ferretti GR , Kocier M , Moro-Sibilot D , et al. Placental transmogrication of the lung: CT-pathologic correlation of a rare pulmonary nodule[J]. AJR Am J Roentgenol, 2004, 183 (1): 99- 101. doi: 10.2214/ajr.183.1.1830099
10	Xu R , Murray M , Jagirdar J , et al. Placental transmogrification of the lung is a histologic pattern frequently associated with pulmonary fibrochondromatous hamartoma[J]. Arch Pathol Lab Med, 2002, 126 (5): 562- 566. doi: 10.5858/2002-126-0562-PTOTLI
11	Shapiro M , Vidal C , Lipskar AM , et al. Placental transmogrification of the lung presenting as emphysema and a lung mass[J]. Ann Thorac Surg, 2009, 87 (2): 615- 616. doi: 10.1016/j.athoracsur.2008.05.076
12	Narula N , Ngu S , Sharma D , et al. Placental transmogrification of the lung associated with unilateral pleural effusion: A case report with a comprehensive review of the literature[J]. Respir Med Case Rep, 2019, 26, 161- 164.
13	Marchevsky AM , Guintu R , Koss M , et al. Swyer-James (MacLeod) syndrome with placental transmogrification of the lung: A case report and review of the literature[J]. Arch Pathol Lab Med, 2005, 129 (5): 686- 689. doi: 10.5858/2005-129-0686-SMSWPT
14	Hamza A , Khawar S , Khurram MS , et al. Pulmonary placental trans-mogrification associated with adenocarcinoma of the lung: A case report with a comprehensive review of the literature[J]. Autops Case Rep, 2017, 7 (3): 44- 49. doi: 10.4322/acr.2017.027
15	Mudawi D , Touqeer R , Montero-Fernandez A , et al. Image of the month: Placental transmogrification of the lung: A rare cause of cystic lung disease[J]. Clin Med (Lond), 2020, 20 (6): 603- 604.
16	Jenkins JM , Attia RQ , Green A , et al. A case of pulmonary placental transmogrification[J]. Asian Cardiovasc Thorac Ann, 2016, 24 (8): 811- 813. doi: 10.1177/0218492316661462
17	Horsley WS , Gal AA , Mansour KA , et al. Unilateral giant bullous emphysema with placental transmogrification of the lung[J]. Ann Thorac Surg, 1997, 64 (1): 226- 228. doi: 10.1016/S0003-4975(97)00274-9
18	Fidler ME , Koomen M , Sebek B , et al. Placental transmogrification of the lung, a histologic variant of giant bullous emphysema. Clinicopathological study of three further cases[J]. Am J Surg Pathol, 1995, 19 (5): 563- 570. doi: 10.1097/00000478-199505000-00008
19	Moneghini L , Tosi D , Graziani D , et al. CD10 and CD34 as markers in vascular malformations with PIK3CA and TEK mutations[J]. Hum Pathol, 2020, 99, 98- 106. doi: 10.1016/j.humpath.2020.04.001
20	Kadota K , Buitrago D , Lee MC , et al. Tumoral CD10 expression correlates with high-grade histology and increases risk of recurrence in patients with stage Ⅰ lung adenocarcinoma[J]. Lung Cancer, 2015, 89 (3): 329- 336. doi: 10.1016/j.lungcan.2015.06.003

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

[1]	沈棋,刘亿骁,何群. 肾黏液样小管状和梭形细胞癌的临床病理特点及预后[J]. 北京大学学报（医学版）, 2023, 55(2): 276-282.
[2]	侯卫华,宋书杰,石中月,金木兰. 幽门螺杆菌阴性早期胃癌的临床病理特征[J]. 北京大学学报（医学版）, 2023, 55(2): 292-298.
[3]	农琳,王微,梁丽,李东,李鑫,李挺. 母细胞性浆样树突细胞肿瘤13例临床病理学特征[J]. 北京大学学报（医学版）, 2023, 55(2): 308-314.
[4]	宁博涵,张青霞,杨慧,董颖. 伴间质细胞增生、玻璃样变性及索状结构的子宫内膜样腺癌1例[J]. 北京大学学报（医学版）, 2023, 55(2): 366-369.
[5]	博尔术,洪鹏,张宇,邓绍晖,葛力源,陆敏,李楠,马潞林,张树栋. 乳头状肾细胞癌的临床病理特征和预后分析[J]. 北京大学学报（医学版）, 2022, 54(4): 615-620.
[6]	吴燕芳,高飞,林滇恬,陈志涵,林禾. 托法替布联合治疗抗MDA5抗体阳性的无肌病皮肌炎并发快速进展型间质性肺病5例临床分析[J]. 北京大学学报（医学版）, 2021, 53(5): 1012-1016.
[7]	夏芳芳,鲁芙爱,吕慧敏,杨国安,刘媛. 系统性红斑狼疮伴间质性肺炎的临床特点及相关因素分析[J]. 北京大学学报（医学版）, 2021, 53(2): 266-272.
[8]	包海荣,刘晓菊,谭恩丽,舒娟,董继元,李盛. 兰州市气温和相对湿度对慢性阻塞性肺疾病患者门诊就诊人次的影响及其交互效应[J]. 北京大学学报（医学版）, 2020, 52(2): 308-316.
[9]	谢江,李菲. 睡眠重叠综合征与糖尿病发病率的横断面调查研究[J]. 北京大学学报（医学版）, 2019, 51(2): 252-255.
[10]	卢昕,张立宁. 肌活检在特发性炎性肌病诊断和临床分型中的价值[J]. 北京大学学报（医学版）, 2018, 50(6): 949-951.
[11]	倪莲芳，王鹤，李虹，张志刚，刘新民. 非人类免疫缺陷病毒感染肺隐球菌病34例临床分析[J]. 北京大学学报(医学版), 2018, 50(5): 855-860.
[12]	黄子雄，杜依青，张晓鹏，刘士军，徐涛. 肾细胞癌骨转移的临床与病理分析[J]. 北京大学学报(医学版), 2018, 50(5): 811-815.
[13]	季兰岚，王鹤，张晓慧，张卓莉 . 甲周毛细血管异常与系统性硬化相关肺间质纤维化的关系[J]. 北京大学学报(医学版), 2018, 50(3): 501-506.
[14]	丁嘉祥, 王梅. 抗中性粒细胞胞浆抗体相关性小血管炎维持性透析患者并发肺出血1例[J]. 北京大学学报(医学版), 2017, 49(5): 915-918.
[15]	吴筱音，李国星，王旭英，梁凤超，潘小川. 北京市大气污染与呼吸系统疾病死亡的相关性——基于卫星遥感数据的时空分析[J]. 北京大学学报(医学版), 2017, 49(3): 409-417.