Grayish‐white component emerging in a dark‐brownish nodule of solitary pulmonary capillary hemangioma after blood drainage and water immersion
Grayish‐white component emerging in a dark‐brownish nodule of solitary pulmonary capillary hemangioma after blood drainage and water immersion
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孤立性肺毛细血管瘤引流水浸后暗褐色结节内出现灰白色成分
DOI：
10.1111/pin.13133
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发表时间：
2021
影响因子：
2.2
通讯作者：
Morikawa Teppei
中科院分区：
文献类型：
--
作者：
Hashimoto Hirotsugu;Matsumoto Jun;Kusakabe Masashi;Miura Sakiko;Amano Yoko;Fukumoto Kento;Hiyama Noriko;Morikawa Teppei
据编辑介绍，外周肺组织主要由肺泡上皮和毛细血管组成。1虽然毛细血管瘤是一种罕见的肺部肿瘤，但孤立性肺毛细血管瘤(SPCH S)最近被认为是良性血管病变，在肺内形成孤立性结节。2SPCH通常无症状，在计算机断层扫描(CT)上发现为小结节，通常为毛玻璃结节(GGNs)。在肉眼检查中，SPCH通常表现为褐色结节；2因此，很难根据CT上是否存在GGNs对其进行识别。在此，我们提出了一例SPCH，在引流和浸水后其大体外观发生了改变。1例43岁女性因胸部CT发现肺部结节而转诊至本院。她过去没有显著的病史。她的祖父得了肺癌。她曾是一名吸烟者，有两年半的吸烟史，但在10多年前戒烟。大约在她第一次来我们医院的5个月前，她以颈部和肩部疼痛为主诉到诊所就诊。这种疼痛在初次就诊后持续了一个多月。随后，胸部CT显示左肺下叶有一个10毫米的结节，尽管这个结节的存在并不能解释她的症状。3个月后随访CT未见明显变化。病人被转诊到我们医院，因为这个结节被怀疑是肺癌。出现时，她的生命体征在正常范围内，体检显示没有异常。血常规包括全血计数、血生化、肿瘤标志物检查均未发现明显异常。胸部CT上，结节直径为10 mm，为半实性结节，位于左肺下叶，由中央实质区和周边磨玻璃区组成。临床怀疑为周围型肺腺癌。在正电子发射断层扫描-CT上，肺结节并未显示氟代脱氧葡萄糖的异常摄取，这与早期腺癌并无不符。没有发现身体其他部位的转移灶，包括肺门和纵隔淋巴结。磁共振成像未发现颅内病变(即脑转移灶)。因此，她接受了机器人胸腔镜S8+S9节段切除术。在手术中，很难触摸到结节；因此，术中不能使用冰冻切片进行病理会诊。福尔马林固定后取材进行病理检查。从胸膜表面看不到结节。切面可见9×6 mm的暗褐色结节(图1a)，触诊轻柔。通过对分支支气管的检查，证实结节位于S8，因为B8ai到达了结节；这与放射学所见相一致。结节的大体形态类似于手术形成的血肿，但不同于周围型肺腺癌。我们试图通过重复地在水中扩张和收缩10分钟来从结节中引流血液，结节中出现了一个微弱的灰白色成分。将切开的标本浸入水中，可使灰白色成分清晰可见(图1b)。显微镜下，结节由毛细血管增生和细胞密度增加组成(-图1c)。…显示，毛细血管在扩张的肺泡间隔内增殖，红细胞明显扩张
To the Editor, Peripheral lung tissue predominantly comprises alveolar epithelium and capillaries. 1 Although capillary hemangiomas are rare lung tumors, solitary pulmonary capillary hemangiomas (SPCHs) have recently been recognized as benign vascular lesions, forming solitary nodules in the lung. 2 SPCHs are usually asymptomatic and are detected as small nodules, typically ground‐glass nodules (GGNs), on computed tomography (CT). SPCHs are usually observed as brownish nodules on gross examination; 2 thus, identifying them based on the presence of GGNs on CT is difficult. Herein, we present a case of an SPCH that demonstrated a change in its gross appearance after blood drainage and water immersion. A 43‐year‐old woman was referred to our hospital because of a nodule detected in the lung on chest CT. She had no remarkable past medical history. Her grandfather had lung cancer. She was an ex‐smoker with a history of 2.5‐pack‐years, but quit smoking more than 10 years ago. Approximately 5 months prior to her first visit to our hospital, she presented to a clinic with the chief complaint of neck and shoulder pain. This pain persisted for over a month following the initial clinical visit. Subsequently, chest CT revealed a 10‐mm nodule in the lower lobe of the left lung, although the presence of this nodule did not explain her symptoms. Follow‐up CT 3 months later showed no obvious change. The patient was referred to our hospital because the nodule was suspected to be lung cancer. At presentation, her vital signs were within normal limits, and physical examination showed no abnormality. No obvious abnormal values were detected on blood examinations, including complete blood count, blood biochemistry, and tumor markers. On chest CT, the nodule measured 10 mm and was a part‐solid nodule composed of a central solid area with a peripheral ground‐glass area, which was located in the lower lobe of the left lung. A peripheral‐type lung adenocarcinoma was clinically suspected. On positron emission tomography‐CT, the pulmonary nodule did not show an abnormal uptake of fluorodeoxyglucose, which is not inconsistent with an early adenocarcinoma. Metastatic foci were not detected elsewhere in the body, including the hilar and mediastinal lymph nodes. Magnetic resonance imaging did not reveal intracranial lesions (ie, brain metastatic foci). Accordingly, she was treated with robot‐assisted thoracoscopic S8+ S9 segmentectomy. During surgery, it was difficult to palpate the nodule; therefore, an intraoperative pathologic consultation using a frozen section could not be performed. The resected specimen was pathologically examined after formalin fixation. The nodule was impalpable from the pleural surface. On the cut surface, a dark‐brownish nodule measuring 9× 6mm was found (Figure 1a), which was palpated softly. By examining the branching bronchi, it was confirmed that the nodule was located in the S8 because B8ai reached the nodule; this was compatible with the radiological findings. The nodule's gross appearance was similar to that of a surgically formed hematoma, and was different from that of a peripheral‐type lung adenocarcinoma. We attempted blood drainage from the nodule by repetitive manual expansion and contraction in water for 10 min, and a faint grayish‐white component in the nodule emerged. Immersing the cut specimen in water clarified the grayish‐white component (Figure 1b). Microscopically, the nodule was composed of capillary proliferation with increased cellularity (-Figure 1c). The capillaries proliferated within the expanded alveolar septa and showed marked dilation with erythrocytes …
影响因子：
2.2
作者：
Isaka, Tetsuya;Yokose, Tomoyuki;Masuda, Munetaka
通讯作者：
Masuda, Munetaka