Multiple pulmonary metastases with halo-sign from malignant mixed Mullerian tumors
Multiple pulmonary metastases with halo-sign from malignant mixed Mullerian tumors
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DOI：
10.3892/ol.2017.7036
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发表时间：
2017-12-01
期刊：
影响因子：
2.9
通讯作者：
Zhou，Qiong
中科院分区：
文献类型：
--
作者：
Tian，Hong-Wei;Yang，Wei-Bing;Zhou，Qiong
肺部是癌症最常见的转移器官之一，但子宫肉瘤并不常见。子宫恶性混合苗勒管瘤 (MMMT) 是一种极其罕见的侵袭性肉瘤，其特征是上皮和间质成分的混合物。有关MMMT肺转移的报道很少。本研究介绍了一名 58 岁女性咯血和绝经后阴道出血的病例。该妇女最初被诊断患有侵袭性曲霉病，胸部计算机断层扫描 (CT) 扫描显示肺部多发结节性混浊，周围有毛玻璃衰减光环（光环征）。病理诊断采用诊断性刮宫术和经皮CT引导下肺活检。最后根据宫颈管、子宫和肺标本的组织病理学检查，显示癌和肉瘤成分混合，形态表现为细胞核深染和坏死，诊断为MMMT伴肺转移。肺标本中波形蛋白免疫组织化学染色呈阳性，p16 局灶性阳性，napsin、细胞角蛋白 7 (CK7)、CK20、癌胚抗原、碳水化合物抗原 125、同源框蛋白 CDX2 和绒毛蛋白呈阴性。该病例强调子宫肉瘤肺转移瘤可表现为晕征，这在肺曲霉病中常见。因此，此类病变的鉴别诊断需予以考虑，并需病理证实。
The lungs are one of the most common organs to which cancer metastasizes, but are a location not common for uterine sarcoma. A malignant mixed Müllerian tumor (MMMT) of the uterus is an extremely rare and aggressive sarcoma, characterized by a mixture of epithelial and mesenchymal components. There are few reports regarding the pulmonary metastasis from MMMTs. The present study presents the case of a 58-year-old woman with hemoptysis and post-menopausal vaginal bleeding. The woman was initially diagnosed with invasive aspergillosis based on a chest computed tomography (CT) scan showing multiple pulmonary nodular opacities surrounded by a ground-glass attenuation halo (halo-sign). Diagnostic curettage and a percutaneous CT-guided lung biopsy were conducted for the pathological diagnosis. Finally, the diagnosis was confirmed as MMMT with lung metastasis based on the histopathological examination of cervical canals, uterus and lung specimens, which showed a mixture of carcinomatous and sarcomatous elements, and morphology exhibiting hyperchromatic nuclei and necrosis. Immunohistochemical staining was positive for vimentin, focally positive for p16, and negative for napsin, cytokeratin 7 (CK7), CK20, carcinoembryonic antigen, carbohydrate antigen 125, homeobox protein CDX2 and villin in the lung specimens. This case highlights that pulmonary metastatic tumor from uterine sarcoma can present as halo-sign, which is commonly observed in pulmonary aspergillosis. Therefore, it needs to be considered in the differential diagnosis of such lesions, and pathological confirmation is required.