Objective To analyze the clinicopathological characteristics of solitary pulmonary nodules (SPN) in patients with primary extrapulmonary malignant tumor, and to evaluate the value of video-assisted thoracoscopic surgery (VATS) in the diagnosis and treatment of the patients. Methods A total of 54 cases of SPN with history of primary extrapulmonary malignant tumor, who were treated by VATS in our hospital from January 2000 to August 2011, were enrolled to this study. We retrospectively analyzed the clinical characteristics, including age, gender, symptoms, disease-free interval between extrapulmonary malignancy and diagnosis of lung nodules, CT morphological characteristics of SPN, the operation information, and postoperative pathohistological characteristics. Results The procedures included wedge resection (n = 36) , segmentectomy ( n = 1) , and lobotomy ( n = 17). Definitive histologic diagnosis included 36 metastatic tumors (66.7% ) , 11 primary lung cancers (20.4% ) , 7 benign nodules ( 13.0% ). Two patients were converted to open surgery. No patients died perioperatively. In the patients with primary lung cancer, 7 were in stage I (63.6% ) , 2 stage II ( 18. 2% ) , and 2 stage Ⅲ ( 18. 2% ). In the patients with primary lung cancer, the disease-free interval between extrapulmonary malignancy and diagnosis of lung nodules ranged from 13 to 276 months with a median of 84 months, which was significantly longer than that in patients with metastatic tumor ranged from 0. 8 to 264 months (median, 18.5 months; Z = -3. 358, P =0.001). In the patients with metastatic tumor, CT examination showed spiculesign in 27.8% of them (10/36), tabulation in 38.9% (14/36), and pleural traction in 11. 1% (4/36). And in the patients with primary lung cancer, CT examination clearly showed the edge of the tumor in 2 of the 11 cases ( 18. 2% ). Patients with history of colorectal carcinoma or bone and soft tissue sarcinoma showed significantly higher rate of metastatic tumor than the patients with histories of other tumors [ 90. 9% (30/33 ) vs. 28.6% (6/21) , x2 =22. 442, P=0.000]. Those whose history of headeck tumors (3/4), renal carcinomas (2/4), and breast cancer (2/4) tended to have primary lung cancer.Conclusions Close to 30% of SPN patients with primary extrapulmonary malignant tumor tend to be misdiagnosed by CT. Around 1/3 of the patients are proved to be primary lung cancer or benign nodules. VATS is a good choice for such patients.%目的 研究伴肺外恶性肿瘤史的孤立性肺结节的临床及病理特点,探讨胸腔镜手术对该类患者的应用价值.方法 2000年1月～2011年8月,胸腔镜手术治疗伴肺外恶性肿瘤史的孤立性肺结节54例,回顾性分析年龄、性别、症状、肺内外病灶的诊断间隔时间、肺内结节的影像学表现、手术情况、术后病理等因素,探讨该类患者的临床病理特征及手术价值.结果 全组手术过程顺利,肺叶及肺段切除18例,楔形切除36例.中转开胸2例,无围手术期死亡.全组手术确诊率100％,其中转移瘤、原发肺癌、良性病变分别为36例(66.7％)、11例(20.4％)、7例(13.0％).原发肺癌Ⅰ期63.6％ (7/11),Ⅱ期18.2％(2/11),Ⅲ期18.2％ (2/11).肺内结节为原发肺癌者肺外肿瘤与肺内病灶确诊间隔时间中位数为84个月(13～ 276个月),转移瘤为18.5月(0.8 ～264个月),差异有统计学意义(Z=- 3.358,P=0.001).转移瘤者胸部CT出现毛刺者27.8％ (10/36),分叶者38.9％ (14/36),胸膜牵拉者11.1％(4/36).原发肺癌呈现界限清楚者18.2％(2/11).既往有结直肠癌或骨软组织肿瘤史者,肺内新发结节为转移瘤的可能性明显高于其他肿瘤史组[90.9％ (30/33) vs.28.6％(6/21),x2=22.442,P=0.000].肺内结节为原发肺癌的比例较大者分别为头颈部肿瘤史(3/4)、肾癌(2/4)和乳腺癌史(2/4). 结论 伴肺外恶性肿瘤史的孤立性肺结节患者中接近30％易被影像学检查误诊,且有1/3为原发肺癌或良性病变.胸腔镜手术是此类患者较好的治疗选择.
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