原发性气管平滑肌瘤一例诊治分析

摘要

目的：探讨原发性气管平滑肌瘤的临床和病理特点,减少误诊、漏诊。方法对收治的原发性气管平滑肌瘤1例的临床资料进行回顾性分析。结果本例为58岁女性,因咳嗽伴发热7 d,胸闷、胸痛1 d入院。胸部CT检查示气管上段后壁结节样占位性病变。支气管镜下活组织病理检查(活检)示：黏膜慢性炎症。 PET-CT检查示胸廓入口水平气管右后壁占位性病变伴氟代脱氧葡萄糖( fluorodeoxyglucose, FDG)代谢增高,恶性病变可能性大；子宫体后壁占位性病变伴FDG代谢增高,子宫肌瘤感染或恶变可能；胃窦部胃壁增厚伴FDG代谢增高(后经胃镜活检明确诊断为胃窦部炎症)。行支气管镜高频电圈套切除病变组织行病理检查确诊为原发性气管平滑肌瘤(排除子宫来源),予对症支持治疗,症状缓解后出院(子宫肌瘤专科治疗)。出院后1个月复查支气管镜示病变创面愈合良好,轻微突出支气管壁,未见明显复发征象,建议继续随访。结论原发性气管平滑肌瘤临床较少见,症状缺乏特异性,易误诊,及时行CT气道三维重建和支气管镜检查,可及早确诊和治疗。%Objective To investigate the pathological and clinical features of primary tracheal leiomyoma in order to reduce the misdiagnosis and missed diagnosis rates. Methods Clinical data of 1 patient with primary tracheal leiomyoma ad-mitted to our hospital was retrospectively analyzed. Results A 58-year-old female was admitted for a cough accompanied by a fever, chest distress and a chest pain. Chest CT showed a nodule on the posterior wall of upper trachea. The pathological re-port of transbronchial biopsy was chronic inflammation of mucous membranes. PET-CT showed the right posterior wall of the thoracic inlet level tracheal for a lesion with increased fluorodeoxyglucose ( FDG) metabolism, indicating that it might be ma-lignant. A space occupying lesion was found on the posterior wall of the uterine body. The FDG metabolism of the lesion was increased. It was not certain whether it was infection of uterine fibroids or malignancy. The wall of the gastric antrum was thickened, with increased FDG metabolism ( which was confirmed by gastroscope biopsy to be astral gastritis) . High frequency electric snare via bronchoscope was used to inspect the lesion which was later confirmed as primary tracheal smooth muscle tumor by pathological examination ( excluding uterine origin) . The patient received symptomatic supportive treatment and was discharged after relief ( uterine fibroids specialist treatment) . One month later, the examination showed that the bronchial wall was healed, and slight extension could be seen. There was no obvious sign of recurrence, and a follow-up was recommended. Conclusion Primary tracheal leiomyoma is rare and not specific. It tends to be easily misdiagnosed as chronic bronchitis and asthma. Early 3-D spiral CT and bronchoscope are helpful in the diagnosis.