Benign lung tumor

Introduction to benign lung tumors Benign tumors of the lungs are relatively rare, and there are many different types of cells that can originate from the lungs and bronchi, with hamartoma being the most common. The vast majority have no clinical signs and symptoms, often found on X-ray examination. Benign tumors can have symptoms: cough, hoarseness, lung infection, and hemoptysis. Benign lung tumors vary in their symptoms depending on their classification. The common clinical feature of benign lung tumors is that most cases are asymptomatic and have no positive signs. They are often found on X-ray examination. Most of the tumors are located in the peripheral part of the lungs, and the volume is small. Most of them are single-shot and round. , elliptical, lobulated or nodular, uniform density, sharp edges, very few burrs. The vast majority have no clinical signs and symptoms, often found on X-ray examination. Some cases may have symptoms such as cough, hoarseness, lung infection and hemoptysis. Benign lung tumors vary in their symptoms depending on their classification. The size and location of peripheral benign tumors determine their performance and rarely cause clinical symptoms. A small number of patients may have clinical symptoms due to large tumors, adjacent bronchial tubes or other unexplained reasons, the most common cough and non-specific chest pain, but also chest tightness, blood stasis, fatigue and so on. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: pneumonia, bronchitis, lung abscess

Causes of benign lung tumors

(1) Causes of the disease

Currently no relevant information

(two) pathogenesis

Benign tumors of the lungs can be divided into two types according to their location:

Peripheral type: also known as peripheral type, the tumor originates from the bronchus or lung parenchyma below the segment. About 90% of the benign tumors of the lower respiratory tract are peripheral type, and about 75% of the peripheral benign tumors are located under the visceral pleura, nearly 60%<3cm. The vast majority of manifestations are single-shot, round or elliptical, with clear junctions.

Central type: Also known as the central type, the tumor originates from the bronchus above the segment or segment and grows into or outside the lumen; it accounts for about 10% of the benign tumor of the lower respiratory tract.

Prevention of benign lung cancer

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Benign lung tumor complications Complications, pneumonia, bronchitis, lung abscess

Benign tumors in the lungs often cause clearance of bronchial secretions, resulting in recurrent pneumonia, bronchitis, lung abscesses, and the like. Limited ventilation results in distal atelectasis or emphysema. It is characterized by cough, cough, chest pain, fever, wheezing and even hemoptysis. If left untreated, pulmonary artery pressure rises later, leading to serious complications such as pulmonary heart disease and respiratory and circulatory failure.

Symptoms of benign tumors of the lungs Common symptoms Lymph node enlargement Lung abscess, low fever, dyspnea, lung infection, lung consolidation

The vast majority have no clinical symptoms and signs, often found on X-ray examination, benign tumors can have symptoms: cough, hoarseness, lung infection and hemoptysis, lung benign tumors vary according to their classification.

The size and location of peripheral benign tumors determine their performance, rarely cause clinical symptoms, more than 60% of asymptomatic, radiological examination by accident only when found, nearly 90% of the examination has no relevant signs, a small number of patients can be compared Large, adjacent to the bronchial or other unexplained and clinical symptoms, the most common cough and non-specific chest pain, but also chest tightness, blood stasis, fatigue and so on.

The size and activity of central benign tumors determine their performance. Most cases have obvious symptoms and signs. Smaller trachea and bronchial tumors have no symptoms. Larger tumors do not completely block the trachea. Smell and wheezing, if the tumor mostly or completely obstructs the respiratory tract, causing: 1 restricted clearance of endocrine secretions, can lead to recurrent pneumonia, bronchitis, lung abscess, etc.; 2 restricted ventilation leads to distal lungs Zhang or emphysema, manifested as cough, cough, chest pain, fever, wheezing and even hemoptysis.

Clinically common characteristics of benign lung tumors:

1. Pulmonary hamartoma The incidence rate is the first in lung benign tumors, the population incidence rate is 0.25%, accounting for 8% of lung tumors, accounting for 75% to 77% of benign lung tumors, accounting for lungs "coins" 80% of the lesions, the annual incidence rate is 1 / 100,000, the source of the lung hamartoma and the cause of the disease is not very clear, the more easily accepted hypothesis that the hamartoma is a piece of tissue in the bronchi in embryonic development During the period of inversion and shedding, it is surrounded by normal lung tissue. This part of the tissue grows slowly, and may not grow for a certain period of time. Later, it gradually develops to form a tumor. The fact that most hamartomas develop after 40 years old supports this hypothesis. WHO classifies hamartomas into the following three categories:

1 chondromatous hamartoma: this type is the most common, typical manifested as cartilage nodules with fibrous and adipose tissue, mixed with bronchial epithelium, calcification or ossification can occur in cartilage or connective tissue, and Radiologically, slow growth is usually asymptomatic, but can be found by routine radiology or autopsy.

2 leiomyomatous hamartoma: the main components of the tumor are smooth muscle and bronchioles, the exact nature is unknown, should be differentiated from smooth muscle hyperplasia, the latter occurs in chronic lung disease,

3 Peripheral hamartoma: located under the pleura, can be multiple, a type of peripheral hamartoma is different from cartilage-type hamartoma, a single non-cilia, tubular epithelium, with immature mucus matrix.

(1) Pathology: The pathological features of hamartoma are abnormal combinations and arrangements of normal tissues. This histological abnormality may be the disorder of the number, structure or maturity of organ tissues. The pathological components are mainly cartilage and fat. Smooth muscle, gland, epithelial cells, and sometimes bone tissue or calcification. The tumor is spherical, oval, and the surrounding connective tissue is divided into leaves, no capsule, but the boundary is clear, no infiltration, only A case report of malignant tumors and intrapulmonary hamartomas, the main components of which are cartilage, fat, fibroblasts and bone tissue, but the proportion of various components is significantly different.

80% of the components of hamartoma in the lung parenchyma are cartilage, 12% are fibroblasts, and fat and bone tissues account for 5% and 3%, respectively. The boundary between normal lung tissue and tumor is unclear or papillary. This is caused by the growth of fibroblasts into the alveolar wall in vitro. The tumor always contains alveolar type II, cilia, non-cilia or mucus-cleaved epithelial cells, which is evidence of multi-center maturation. Lymphocytes, plasma cells and macrophages are common inflammatory exudation around the tumor, and some of the plasma cell granuloma or non-caseous granuloma can be seen. However, no evidence of microbial presence is found in the examination of granuloma. The patient is not a sarcoidosis patient, and multiple hamartomas. In most cases, the tissue components of different tumors are similar, only a few cases are different, or cartilage components, or fibrous tissue components.

The components of endobronchial hamartoma account for 50% of cartilage-like tissue, 33% of fat, 8% of fibroblasts, and 8% of bone components. There is no anatomical relationship between cartilage-like tissue and tracheal cartilage. The bone component is always located in the cartilage component. It is also manifested by cartilage metaplasia. The naive, activated fibroblasts are scattered around the cartilage in an orderly manner, secreting the serous fluid. The mucous glands are scattered in the fat and fibroblast structure. The surface of the tumor is composed of the respiratory epithelium. Covering, the cartilage tissue is often nodular, which makes the tumor show lobulated characteristics, which may be caused by multi-center growth, 75% of the tumor surface is smooth, and 25% of the surface is papillary.

(2) Symptoms: The literature reports that males are more common. The ratio of male to female is 2:1 to 3:1. The peak age of onset is 60-70 years old. 86% of patients have a history of smoking. The average smoking history is 44 packs. Intrapulmonary hamartoma (about 80% or more) grows in the peripheral part of the lung, close to the visceral pleura of the lung, sometimes protruding on the surface of the lungs, only a few cause symptoms, and there is no positive sign in the examination, only the wrong When the tumor is developed to a certain size, enough to stimulate the bronchi or compression of the bronchi to cause bronchial stenosis or obstruction, cough, chest pain, fever, shortness of breath, blood stasis, and even hemoptysis, etc., on the contrary, the trachea and endobronchial hamartoma are mostly There may be respiratory symptoms within 3 months before diagnosis. An average of 40% have one or more pulmonary symptoms. The symptoms are cough, belching and recurrent pneumonia. Symptoms such as hemoptysis and chest pain are rare. Clinical signs such as wheezing Or tubeatic breath sounds.

Pulmonary hamartoma can also be a local manifestation of systemic diseases. The following systemic diseases are common. Carney's triad (Carney triad): bronchial chondroma, multiple gastric leiomyosarcoma, adrenal pheochromocytoma, Cowden syndrome: external Multiple hamartoma of the germ layer, mesoderm, and endoderm organs, hamartoma syndrome: a hamartoma with other dysplasia or benign tumors is called hamartoma syndrome, and most of these patients are patients with Cowden syndrome. The combined diseases include: various warts, hypertension, arterial stenosis, congenital heart disease, digestive tract diverticulum, etc., its characteristics: 175% have more than two diseases; 2 are rare or rare diseases; 3 the disease is more serious than ordinary people, but because of There was no specificity in the combined disease, and there was no obvious correlation, so some people raised objections.

(3) X-ray examination: Pulmonary hamartoma is mostly single, only 2.6% is multiple, and more than 2 tumors, more common in the lung parenchyma, more than 90% located in the lung, The bronchial lumen type is rare, with more left lungs in the right lung, more in the lower lobe, and some in the right middle lobe and upper left lobe. The tumor of the lung hamartoma is larger, with a diameter of 0.2~. 9.0cm, the maximum diameter of up to 30cm, an average of 1.5 ~ 1.9cm, the hamartoma in the bronchi is less common, accounting for 1.4% to 19.5%, the volume of the intrabronchial hamartoma is small, the diameter is 0.8 ~ 7.0cm, the average It is 2.1cm, and it is most common in 1 to 3cm.

80% is round, 20% has lobulation, 10% to 30% can be seen calcification, eccentric calcification is the most common, central calcification is rare; popcorn sign is a characteristic manifestation of pulmonary hamartoma, but rare and not Pulmonary hamartoma is unique.

Most X-rays show uniform and dense shadows, and can also be uneven shadows. Bronchial hamartomas often show atelectasis of affected lung tissue, and emphysema, lung consolidation, patchy calcification, etc. Rarely, about 53% of patients have no shadow on chest X-ray examination 1 to 18 years before surgery, while about 47% have shadows. According to the long-term follow-up chest X-ray, the structure is measured. The growth rate of the tumor is (diameter) 1.5 to 5.7 mm per year, and the doubling time is 14 years, and the growth rate has nothing to do with age.

(4) Percutaneous biopsy: 85% can be diagnosed, mainly differentiated from inflammation and metastatic lesions. Some cases are accidentally discovered during surgery, and there are also patients with lung cancer. Their characteristics are: they are often located in the same lobe as lung cancer. The tissue types of lung cancer include squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma.

(5) Treatment: Resection is the most effective treatment. Small hamartomas in the trachea or proximal bronchus can be removed by bronchoscopy or laser ablation. If the tumor is larger or located in the distal bronchus, it is feasible. Pulmonary resection, segmental resection, tracheal, bronchial reconstruction or endotracheal resection, hamartoma in the periphery of the lung, can be locally resected by thoracoscopic surgery, and sent to the frozen examination to confirm the diagnosis. If other malignant tumors are combined, the lung cancer is suspected. Large or tumor located in the center of the lung, feasible lung segment, lung lobe, double lobe resection, such surgery only accounted for 13.2%, and most patients only need to remove the local resection.

(6) Follow-up: About 1.4% of patients relapsed in the same lobe 10 to 12 years after surgery. Most of the recurrences were chondroma-based hamartomas. There was no difference in the components before and after recurrence. The main reason for post-recurrence is that there is no evidence of malignant transformation of dysplasia. A case report of isolated lung adenocarcinoma metastases found in intrapulmonary chondromatous hamartoma, the surrounding lung tissue is normal, 3.6% postoperative 1~ Lung cancer occurred in 7 years, mostly squamous cell carcinoma and adenocarcinoma, but they were all in different lung lobe. Compared with those with lung cancer at the same time, the latter were mostly in the same lobe.

2. Pneumonia pseudotumor is a granuloma caused by chronic inflammation in the lungs, mechanized, fibrous connective tissue hyperplasia and related secondary lesions form a tumor-like mass, not a real tumor, pneumonia pseudotumor is more common, in recent years The number of reports in the literature has increased, ranking second in the lungs.

Pneumonia pseudotumor is generally located in the lung parenchyma, only a small number of bronchial involvement, the vast majority of single, round or oval nodules, generally no intact capsule, but the mass is more limited, the tumor is hard, yellow-white The border is clear, and some of the collagen fibers are thicker and lack of cells. The connective tissue is separated from the lung parenchyma. A few pneumonia pseudotumors can be cancerous. The histology of the tumor is pleomorphic, containing granulation tissue, arranged in strips. Fibroblasts, plasma cells, lymphocytes, histiocytes, epithelial cells, and foam cells or pseudo-xanoma cells containing neutral fat and cholesterol are mainly mature plasma cells.

Patients with pneumonia pseudotumor are more common in young adults. The general age of onset is 30 to 40 years old, more women than men, and 1/3 of patients have no clinical symptoms. Only by accidental X-ray examination, 2/3 patients have chronic bronchus. The history of inflammation, pneumonia, lung purulence, and the corresponding clinical symptoms, such as cough, cough, low fever, some patients have chest pain, blood stasis, and even hemoptysis, but the amount of hemoptysis is generally less.

The three outcomes of inflammatory pseudotumor: absorption dissipated, relatively stable, slow growth, the diagnosis of pneumonia pseudotumor has certain difficulties, the clinical symptoms of patients are more difficult to distinguish from chronic bronchitis and lung malignant tumor, chest X-ray examination is round or elliptical, and the smooth and sharp nodules on the edges can be calcified, some edges are blurred, and there are burrs or lobes. It is difficult to distinguish from lung cancer. Pneumonia pseudotumor is not clear in the lungs. Most of the hair parts are below 4cm. These are difficult to diagnose accurately before the diagnosis of pneumonia pseudotumor. It is especially difficult to distinguish from lung cancer, and occasionally may be cancerous. Therefore, it is generally advocated for early surgery and intraoperative pathological cryosection. After a clear diagnosis and determination of benign nature, the operation is based on the principle of preserving normal lung tissue as much as possible. The inflammatory pseudotumor on the surface of the lung is not difficult to remove. The inflammatory pseudotumor located in the lung parenchyma can be treated with local wedge resection or segmental resection. Except for huge masses and invaded bronchus, lung lobe and total lung resection are generally not performed, and the prognosis is good.

3. Papilloma is initially considered to be a benign tumor of the larynx. In addition to recurrent respiratory papilloma, other types of causes are unknown. WHO is divided into two types according to the tissue origin of papilloma: squamous cell papilloma, migration (cell) papilloma, a papillary mass that protrudes into the bronchial lumen, has a fibrous tissue nucleus, and is covered with a stratified squamous epithelium, and the epithelium is occasionally mixed with mucus-producing cells. Connective tissue pedicle has lymphocyte exudation, rare in single hair, can coexist with similar lesions in the pharynx, young people are more common, transitional (cell) papilloma: covered with a variety of epithelium, including epithelium, columnar epithelium or cilia Epithelial, etc., can also be seen in focal squamous metaplasia and mucus secretion components, which can be multiple, even if there is no change of atypical hyperplasia, postoperative recurrence, there may be malignant transformation, the tumor may originate from the basal cells of the bronchi or its reserve cells .

(1) Single papilloma: a rare benign tumor of the lower respiratory tract, accounting for 4% of the benign lower respiratory tract benign tumor, which is currently thought to originate from the trachea, bronchial epithelium and its mucosal glands, excluding its origin in Kultschitzky The cells can coexist with other benign lung tumors such as cystadenoma. The tumor can be located in any part of the bronchial tree, but it is more common in the leaf or segmental bronchus. The histological classification is mostly squamous cell papilloma, and a few are located in the peripheral lung tissue. , composed of similar transparent cells or mixed epithelial cells.

1 clinical manifestations: more common in people over 40 years old, manifested as chronic cough, wheezing, recurrent pneumonia and asthma-like symptoms, some patients can cough up the tumor tissue, because it is located in the bronchi, so the chest X-ray is rare Seeing the tumor, CT or bronchial body image examination is often required. CT can be confirmed as non-exoplastic tumor and no mediastinal lymphadenopathy. Bronchoscopy can be seen in active tumors and bronchodilatation expansion secondary to tumors.

2 differential diagnosis: single papilloma is easy to be confused with bronchial chronic inflammatory polyps, the latter pathology can be seen in chronic inflammatory vascular hyperplasia and edema of granulation tissue, all or part covered with normal ciliated columnar respiratory epithelium, no papillary Surface structure.

3 treatment: radical surgery is the best treatment, generally tracheal resection or sleeve resection, if the distal lung tissue irreversible damage, can also be removed together with the lung tissue, but lobectomy should be avoided, Although endoscopic resection can alleviate the symptoms, but the effect is not thorough, laser burnout can also be used. There are cases of postoperative malignant cases, and there is very little recurrence after resection. Some people think that nearly 50% of single bronchial papillomas eventually lead to Lung cancer, another person found that in the bronchial epithelium adjacent to the papilloma, focal carcinoma in situ can be seen, which may be malignant itself, or may be cancerous changes in adjacent tissues.

(2) multiple papilloma: more common in children under 5 years old, rare after 15 years of age, due to human papilloma virus (HPV) type 6 or 11 subtype infection, such patients also Known as recurrent respiratory papillomatosis, tumors often occur in the upper respiratory tract such as epiglottis, throat, etc. It is rare that the lower respiratory tract is the first site, and some patients can heal themselves.

1 clinical manifestations: hoarseness, late visible wheezing and tracheal obstruction, due to large distal bronchial RRP caused by tracheal obstruction, radiological findings of atelectasis, pneumonia, abscess and bronchiectasis, the diagnosis is endoscopy And biopsy.

2 treatment: There is no effective treatment at present. The available surgical methods are: A. surgical resection or laser burnout; B. cryotherapy, diathermy; C. adjuvant therapy, such as: fluorouracil (5-FU) ), corticosteroids, vaccines, pudaflurane, high-dose vitamin A and interferon, etc., should pay attention to tracheotomy can lead to RRP dissemination, its fatal high-risk factors are subglottic papilloma and long-term tracheal intubation.

3 Prognosis: 2% to 3% of patients can have malignant transformation, and those with malignant transformation are mostly those with long-term medical history (more than 10 years). Their common features are: early diagnosis in infants and young children, repeated surgery or tracheotomy due to serious illness. In the 20s, the squamous cell carcinoma becomes squamous cell carcinoma. After malignant transformation, it is often short-term (average 4 months). The high-risk factors of dissemination or malignant transformation include radiotherapy (children), smoking (adult), tracheal intubation and pulmonary parenchyma. For lesions, etc., about 15% of the above high-risk factors can cause malignant transformation.

4. fibroids are rare in the lung parenchyma, can be seen at any age, see men and women with similar incidence, tumors can be pedicled, the capsule is intact, the texture is different, there may be calcification, there is epithelial coverage, there are different degrees of blood vessels visible on the surface, under the microscope : It manifests as a simple cell-free fibrous tissue, or a loose fibrous structure. It also has cystic changes or ossification. It grows slowly. Under the bronchoscope, there are nodular or pedicled polyps in the lumen. The mass of the tumor is 2 to 3.5 cm in diameter. The fibroids in the atmospheric tube can be laser-burned or endoscopically removed, and the intrapulmonary fibroids can be conservatively removed.

5. Chondroma is the most common intrabronchial tumor located in the cartilage of the bronchial wall. It is rare in the lung parenchyma. Franco suggests that chondroma refers to benign tumors containing only the mesoderm cartilage component and should not be confused with hamartoma. The latter contains connective tissue and epithelial tissue, tumors with very few tumors >5cm, clear boundary with normal lung tissue, smooth surface or nodular sensation, can have lobes, envelope, solid, hard, translucent Easy to peel off, the profile is yellow, white or brown, the edge of the tumor is harder than the center, visible ossification or calcification, like eggshell, under the microscope: cartilage tissue covered with epithelium, no glands and other ingredients, male and female The rate is similar, age: 20 ~ 64 years old, is the typical clinical manifestations of lower respiratory tract benign tumors, lung chondroma is difficult to diagnose before surgery, recurrence after resection, occasionally evil to chondrosarcoma, and recurrence of malignant chances, Chondromas encourage an extended range of resection.

6. Carney syndrome This syndrome is the first case reported by Carney in 1977. This syndrome refers to three different tumors occurring simultaneously in three different organs: gastric leiomyosarcoma, extra-adrenal pheochromocytoma And lung hamartoma, the above three kinds of tumors can be diagnosed as Carney syndrome as long as two species are found at the same time, and other reports can be combined with breast fibroma, this syndrome is more common in young women, aged 7 to 37 years old, patients with multiple causes The symptoms of the first two tumors are treated. Only the first symptoms of the first case are in the lungs. For women under 40 years old, if one of the above three tumors is found, it should be comprehensively examined. If the patient is diagnosed with Carney syndrome before surgery, local resection is often used. Surgery.

7. Lipoma originates from mesoderm. Lower respiratory tract lipoma accounts for 0.1% of all lung tumors and 4.6% of benign lung tumors. It is mainly located in the submucosal layer of the air wall, extending from the large bronchial wall to the bronchioles, although subcutaneous. The lipoma in connective tissue is mostly multiple, but the lipoma in the bronchi is almost single, male is more common, female only accounts for 10% to 20%, the age of onset is most common in 40 to 60 years old, and the symptom period is several weeks. In 15 years, in addition to the typical symptoms, there is no blood stasis in the lipoma, so there is no blood stasis, but if the infection is combined, there may be blood stasis.

X-ray chest radiographic features: peripheral lipoma has low shadow density, lung texture in the shadow, central bronchoscopy sees a round, active polypoid mass, the base is narrow and small, forming a pedicle, smooth surface It is yellow or grayish yellow. Most of the lipomas are dumbbell-shaped. The main body is located outside the trachea, and the narrow neck is located in the connecting cavity of the bronchial wall and the outer tumor.

Because the tumor is located in the bronchus, the tumor is much smaller. If the distal lung tissue is normal, tracheotomy or bronchial sleeve resection can be performed. The smaller endoluminal type can be removed under endoscopy.

8. Leiomyomas Pulmonary leiomyoma is one of the early recognized benign lung tumors, which accounts for about 2% of benign lung tumors, as it can be single or multiple, and lung lesions can be other The site is metastasized, especially related to uterine subserosal leiomyoma, and there are reports of multiple subcutaneous tumors. The tumor can be located in the trachea, bronchus, or in the surrounding lung tissue. The incidence is similar, and the bronchial leiomyoma is similar. From the smooth muscle layer of the bronchial wall, the peripheral type of the lung may be derived from the muscle layer of the small trachea or blood vessels, and multiple patients may also be derived from the metastasis of extra-pulmonary leiomyoma.

Generally: the leiomyomas in the trachea and bronchus are mostly located in the membrane section (posterior segment) of the lower third of the trachea. There is no significant difference in the incidence of bronchus in the left, right and each leaf. It is a polypoid growth in the lumen, such as a tongue. The base is wider, occasionally slender pedicle, spherical or surface slightly nodular, more <4cm, individual >6cm, with envelope, solid, hard and tough, cut surface gray, pink tumor-like tissue The tumor in the lung parenchyma is mostly single hair, varying in size, up to 13 cm in size, spherical, lobulated, enveloped, and other features similar to the intrabronchial growth of the tumor, and cystic changes, Most of the cystic variants have large cystic manifestations. The tumor around the lung can be a pedicled polypoid tumor that grows into the pleural cavity.

Microscopically: the tumor in the trachea is composed of smooth muscle as the main component, and there are fewer blood vessels and fibrous tissues. The leiomyomas in the lung parenchyma are more fibrous tissue and vascular components than the intraluminal leiomyoma, and the tumor cells are fusiform under the microscope. The cytoplasm is rich, deeply stained, and there is no nuclear fission. The longitudinal myofibrils are seen. The tumor cells are bundled or swirled. The interstitial fibers and vascular tissues of the tumor tissue, such as fibrous tissue components, are also called fibers. Leiomyoma.

More common in young and middle-aged people, 5 to 67 years old, an average of 35 years old, more women than men, male to female ratio of 2:3, radiology has no characteristic performance, its shadow density is higher than lipoma, the preferred surgical treatment The bronchus without distal lung injury can also be removed by bronchoscopy. The benign metastatic leiomyoma in women has a regression after resection of the ovaries. Neonatal congenital multiple leiomyoma often leads to intestinal obstruction. And fatal complications such as pneumonia.

9. Leiomyomasis Steiner first used the term "metastatic fibrosarcoma" in 1939 to report a 36-year-old female patient with right heart failure due to an excessive mass of the lungs. Martin divided the lung smooth muscle lesion into Category 3: leiomyomatosis in men and children, metastatic leiomyomas in women, and multiple fibromyoma-like hamartomas in the lung.

Steiner defined metastatic leiomyomatosis at the time: histologically primary and metastatic lesions were benign, composed of well-differentiated smooth muscle cells and connective tissue. Multifactorial leiomyomas invaded the uterus vein, causing lungs The possibility of implantation in the tissue, the formation of female-specific lung metastatic leiomyomas, lung multiple fiber leiomyosarcoma-like hamartoma are also found in women, aged 30 to 74 years, and a history of uterine fibroids.

Pulmonary leiomyomatosis is generally asymptomatic. A small number of patients have cough and shortness of breath. Radiological examination shows multiple nodules in both lungs, and even diffuse nodules. In severe cases, lung function can be affected, and long-term follow-up shadow development is slow. There are also cases in which the shadows self-resolved after childbirth. Pathology sees smooth muscle and connective tissue, lack of mitotic figures, adenoid structure composed of alveolar or bronchiole epithelium, metastatic leiomyomas of women and multiple fibromyoma of lung The hamartoma is related to estrogen and progesterone. When the above hormone content is increased, the tumor is enlarged. After the above hormone levels are decreased, the tumor shrinks. After menopause, the disease tends to be stable. For patients who are still in ovarian function, all Uterine and double attachment resection is expected to inhibit the development of this disease.

10. Pulmonary meningioma The meningioma in the lung parenchyma may be primary or metastatic. Primary meningioma is more common in women. It is more common in 40-70 years old, more asymptomatic, and the chest radiograph is nodular, macroscopic view. : The boundary is clear, spherical, with a diameter of 1.7-6.0cm, and the cut surface is grayish white. Light microscopy: The tumor consists of meningeal cells containing the tumor-like body. Electron microscopy: the interlaced cell membrane and desmosome are visible. Vimentin immunostaining tumor cells are all Positive, epithelial membrane antigen (EMA) immunostaining part is positive, but keratin, S-100 and neuron specific enolase immunostaining is negative, intrapulmonary meningioma may be metastatic lesions of intracranial lesions, so it should be comprehensive Exams, in addition to intracranial lesions, the treatment of primary pulmonary meningioma is surgical resection, the prognosis is good.

11. Vascular Tumors Benign vascular tumors of the lower respiratory tract include: hemangioma (divided into cavernous hemangioma, capillary hemangioma and mixed hemangioma), hemangioendothelioma, lymphangioma, and the like.

(1) Hemangioma: It occurs in the throat of an infant, under the glottis or in the upper part of the trachea, which may cause obstruction of the trachea, possibly accompanied by hemangioma of the skin or submucosa in other parts. The general view may be single or multiple. A localized mass, dark purple or red, may have an envelope, a thin-walled input artery and an expanded output vein, with a varicose vascular sinus. Bouer first reported in 1936 that a patient with pulmonary hemangioma ruptured, Hepburm The first successful removal of pulmonary hemangioma in 1942.

(2) pulmonary cavernous hemangioma: rare, but the most common type of hemangioma, may be associated with hereditary hemorrhagic telangiectasia, microscopically seen the expansion of the vascular sinus, sinus covered vascular endothelial cells, There is fibrous tissue space around, capillary hemangioma: the hemangioma located around the lung can protrude from the lung surface, showing unevenness, no capsule, slightly hard, easy to peel off, and a network of small blood vessels under the microscope. It is covered with endothelial cells, and there are a lot of red blood cells in the cavity. A small amount of fibrous tissue and inflammatory cell infiltration can be seen in the periphery. Because there is no obvious clinical symptoms, this tumor is mostly found at autopsy. It is asymptomatic, symptomatic, and hemoptysis is better than other benign tumors. Prominent, fluoroscopy can change the lung shadow with the size of the breathing, X-ray chest and CT show spherical shadow without obvious lobes, diameter 2 ~ 12cm, most common 4 ~ 6cm, uniform density, clear edge, smooth, no cavity Occasionally, meniscus or annular calcification (venous stone), such as a segmental dilated hemangioma, the image can be expressed as a dumbbell or beaded shadow, sometimes visible connected to the hilar and mass This is a vascular tumor blood vessel, angiography can be diagnosed, bronchoscopy can be diagnosed, must pay attention: bronchoscopy biopsy can cause massive bleeding, rescue will not suffocate and die, radiotherapy is effective, because the disease is rarely involved Tracheal incision below the tracheal level, so tracheotomy can be used to treat tracheal obstruction, a single pulmonary cavernous hemangioma can be surgically removed.

(3) Hemangioendothelioma: This disease is common in the skin, breast and liver. It is rare in the lungs. It is a benign tumor, but it has malignant manifestations. The tumor has no capsule, the boundary is unclear, the texture is soft and tough, because there are solid ingredients. Therefore, it is not easy to be compressed. Under the microscope: it is a polygonal or fusiform tumor cell with few cytoplasm and large nucleus. The tumor cells are arranged in a tubular shape, nested or irregularly shaped, and there are cavities or irregular fissures in the tumor. There are many blood components in these gaps, which are most common in infants and young children. They can be combined with congenital heart disease. Radiology often shows nodular shadows in single lung parenchyma. The edges are clear, the density is uneven, and it can also be expressed as bronchial polypoid. Lesions can lead to hemothorax or hypertrophic pulmonary osteoarthrosis. The best treatment is to remove the tumor as soon as possible. The effect of chemotherapy and chemotherapy has not been determined, and patients often die in a short period of time.

(4) glomus tumor: Hussarek (1950) reported the first intratracheal glomus tumor, which can occur in the skin, bones, lungs, and gastrointestinal tract. It is currently thought to stem from a special arteriovenous shunt ( The cells of Sucquet-Hoyer channel are mostly located in the trachea, often single, malignant glomus tumors are rare, and more manifestations are local infiltration. Only a few cases of extensive metastasis have been reported, which may cause dyspnea and hemoptysis. Must be differentiated from angioendothelioma, carcinoid and pheochromocytoma, because it is easily misdiagnosed as carcinoid under light microscopy, and there is no carcinoid-like neuroendocrine granule in the cytoplasm of glomus tumor cells under electron microscope, which can be laser burned off. The prognosis is good and there are cases of postoperative recurrence.

12. Granulous myoblastoma Abbreviated as granulosa cell tumor. In 1926, Abrikossoff reported a case of granulosa cell tumor of the tongue. This is the first granulosa cell tumor found in humans. Therefore, this type of tumor is also called Abrikossoff. Tumor, in 1939, Kramer reported the first intrabronchial granulosa cell tumor, the exact source of which is unknown, may be derived from the original myoblasts, tissue cells or neuromembrane cells, which is currently considered to be the most likely, mainly Benign, often occurs in the tongue, skin and mucous membranes, breast, respiratory and digestive tract are infrequent occurrences, also occur in the myocardium, mediastinum, retroperitoneal reports, granulosa cell tumors are rare in the lower respiratory tract, only 2% to 6% The granulosa cell tumor is located in the respiratory tract.

Pathology: Respiratory granulosa cell tumors are mostly located in the main bronchus, occasionally located in the surrounding lung tissue, 4% to 14% are multiple, some patients may be accompanied by other parts (such as: tongue, skin, esophagus, lymph nodes, etc.) granulosa cells Tumors, characterized by multi-center features; if multiple organs are involved, there is a possibility of malignancy, and histology may have invasive manifestations.

Rough: mostly pedunculated or pedunculated polypoid white nodules, can also be expressed as mucosal sputum thickening, the surface of the tumor is smooth, the boundary is clear, no capsule, the diameter of the tumor is 0.5 ~ 6.5cm, mostly 2 to 3 cm in size, about 20% of granulosa cell tumors grow along the bronchial mucosa, occasionally invading the surrounding lung tissue, but local diffusion does not necessarily suggest malignancy.

Microscopic: consists of large oval or polygonal cells arranged in irregular strips or nodules. The boundaries between tumor cells are clear, but the cell boundaries in the central region of the tumor are unclear, such as syncytial cells, immune group. S-100 protein, NSE, KP1 (CD68) and vimentin positive; no desmin, keratin or P53 oncoprotein expression, under PAS staining, these cells are rich in eosinophilic cytoplasmic granules Should pay attention to the identification of bronchial adenoma, polyps, hamartoma, granuloma, arteriovenous malformations and other malignant tumors.

The incidence rate of men and women is similar, can occur at any age, the most common in 30 to 50 years old, the average age of onset is 37 years old, black people are more common than other ethnic groups, those around the lungs can be asymptomatic, accidentally discovered due to other diseases. However, the vast majority of tumors are located in the bronchus or trachea, which can cause obstructive pneumonia, hemoptysis, hernia or cough; bronchoscopy biopsy can confirm the diagnosis.

According to the size of the tumor in the bronchial lumen and the extent of invasion of the bronchial wall, the surgical method should be surgically removed. The tumor and its obstructed distal lung tissue should be resected. Because of its local invasiveness, it can recur, regardless of bronchoscopy or It is surgical resection, it must be thorough, because it can not be clear the depth of its invasion of the tracheal wall, it is not suitable for microscopic resection. If the tumor diameter is >8mm or CT indicates the surrounding tissue invasion, it often indicates that the tumor has invaded the tracheobronchial cartilage, so only Surgical resection can avoid recurrence. It is recommended that postoperative radiotherapy, 6% of non-respiratory granulosa cell tumors are malignant and distant metastasis, while lower respiratory tract granulosa cell tumors have reports of adjacent lymph node metastasis, but no distant metastasis Reported; about 10% of local excisions relapse within 2 years.

13. Benign clear cell tumors Also known as glycomas, Leibow and Castleman first reported in 1963 that the organization was unknown. According to light microscopy, histochemistry, and ultrastructural studies, the tumors were derived from bronchiole-free ciliated epithelial cells ( Clara cells) or epithelial serous cells, some cells in the tumor have been found to have neuroendocrine function, but the source of tumor cells is not certain, possibly derived from Kulchitsky cells.

Rough: located in the lung parenchyma, the tumor is spherical, with or without capsule, clear boundary with normal tissue, smooth surface, flexible, solid, cross-section fish-like, dark red or grayish yellow, occasional small cyst, tumor The body is not connected to larger blood vessels or bronchus.

Microscopically: tumors resembling adrenal glands are consistently large transparent cell components arranged in acinar, nested or papillary, cytoplasm rich in glycogen for histological features, capillaries visible around, PAS staining positive, and The biggest difference in renal clear cell carcinoma is that the latter does not have a large amount of glycogen, but is replaced by a large number of lipids, while other tumors derived from argyrophilic cells, such as carcinoid, small cell carcinoma, etc., due to glycogen-free, PAS staining Negative, 75% of patients occurred in 45 to 60 years old, there was no difference in the incidence of men and women, all patients were asymptomatic, X-ray chest showed a single, peripheral nodules, diameter 1.5 ~ 6.5cm, rarely more than 4cm There is no report of preoperative diagnosis. Because it is very rare, in the pathological diagnosis, primary clear cell lung cancer and metastatic renal clear cell carcinoma should be excluded. Surgical resection can be cured.

Radiological findings: mostly single-shot, the incidence of both lungs is similar, seen in any lung lobe, clear nodular shadows, more than 4cm, diameter 0.7 ~ 16cm, can be solid or focal liquid cavity, density Can be even or uneven, such as chronic inflammation in the surrounding tissue, the lesion can be diffuse in the leaves, the boundary is unclear, the tumor grows slowly.

The CT image is the closest benign tumor to lung cancer. The characteristics are as follows: most of them are located around the lung, with a wedge-shaped shadow pointing to the hilum. The pleural reaction is thickened and deformed around the lesion, and the shadow is visible near the side. The large texture pointing to the hilar is caused by insufficiency of inflammation. It is often seen that there are multiple shadows in the ipsilateral lung. Most patients are misdiagnosed as lung cancer before surgery.

Because it is easily misdiagnosed, regardless of whether it is preoperative diagnosis, it should be actively surgically removed, the operation can confirm the diagnosis and cure the disease, and the prognosis is good.

14. Sclerosing hemangioma The etiology and pathogenesis are not well understood. Patients may have a family history, but most electron microscopy studies have shown that the cell origin is epithelial cells. The histological features of pulmonary sclerosing hemangioma are: 1 solid cells There are white blood cells scattered in the lumps and mucus-like stroma; 2 aneurysmal hyperplasia accompanied by tube wall hardening tendency; 3 small proliferative small blood vessels appearing in the air cavity; 4 there is bleeding and hardening area, in addition, fat and irony blood can be seen The flavin infiltrates into the interstitial tissue and spreads into the alveoli.

With the application of electron microscopy and histochemistry, immunohistochemistry in tumor diagnosis, the diagnosis of pulmonary sclerosing hemangioma has gradually become clear. The results show that pulmonary sclerosing hemangioma is an epithelial tumor with granular alveolar cells and primitive

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