【呼吸系统】黏液表皮癌

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【黏液表皮癌】

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1

病史

6/F, intermittent low grade fever for two months. No cough, breathlessness or weight loss. Elevated ESR.

6岁女孩，低热2月。无咳嗽，气短及体重减轻。ESR升高

2

影像学检查

图1 胸片正位

图2 胸部CT增强纵隔窗

图3 胸部CT肺窗

图4 胸部CT肺窗

3

影像学表现

PA chest radiograph shows a mass-like density overlying the right hilum.
胸片正位显示右肺门肿块样高密度。

Mediastinal setting of the chest CT scan shows a well-defined, lobulated, enhancing lesion in the apical segment of the right lower lobe with a small right hilar node. The lesion shows no internal calcification or fat density.
胸部CT纵隔窗显示右肺下叶背段病变，边界清楚，分叶状，增强后有强化，伴右肺门小淋巴结，内无钙化和脂肪密度。

Lung window reveals that the apical segmental bronchus cannot be separately visualized from the lesion and that the distal sub-segmental bronchi shows mild bronchiectasis. There is no air trapping / atelectasis or consolidation peripheral to the lesion.
胸部CT肺窗显示病变与右肺下叶背段支气管分界不清，远侧亚段支气管轻度扩张。病变周围无空气潴留、肺不张或实变。

4

诊断

mucoepidermoid carcinoma

黏液表皮癌

CT guided biopsy proved the diagnosis of low grade mucoepidermoid carcinoma, and right lower lobectomy was subsequently performed.
CT引导下穿刺活检证实低级别黏液表皮癌，后行右肺下叶切除术。

Pathology showed a lobulated solid mass arising from the apical segmental bronchus.
病理显示分叶状实性肿块来源于背段支气管。

Histopathology revealed an admixture of mucinous and intermediate type cells with tumor lobules pushing against the adjacent lung parenchyma, with no tumor associated atelectasis. The hilar node was also resected and was negative for tumor.
组织病理学显示粘液和中间型细胞混合，肿瘤压迫邻近的肺实质，无肿瘤所致肺不张。肺门淋巴结阴性。

5

诊断要点

Mucoepidermoid carcinoma is a malignant glandular epithelial neoplasm.
黏液表皮癌是一种恶性腺体上皮肿瘤。

It is most commonly seen in the salivary glands, however, can be seen in the breast, pancreas, thyroid, trachea and bronchus, albeit rarely.
黏液表皮癌最常见于唾液腺，然而，也可见于乳腺、胰腺、甲状腺、气管和支气管，尽管罕见。

Pulmonary mucoepidermoid carcinoma is a rare occurrence and represents only 0.1 to 0.5% of all lung carcinomas, however, is among the common childhood primary malignant tumors of the lung accounting for 10% of cases.
肺黏液表皮癌发生率低，仅占肺癌的 0.1 - 0.5%，是儿童常见肺原发性恶性肿瘤之一，占10%的病例。

Since pulmonary carcinoma is rare in children, primary diagnostic consideration is given to respiratory tract infections and is empirically treated; hence, carcinomas are detected late.
由于肺癌在儿童中很罕见，最初诊断考虑呼吸道感染，并予以经验进行治疗；因此，确诊较晚。

Mucoepidermoid carcinoma commonly presents with cough, hemoptysis, wheezing, chest pain, fever and sometimes clubbing of fingers.
黏液表皮癌通常表现为咳嗽、咯血、喘息、胸痛、发热和杵状指。

In a child with recurrent pneumonia or hemoptysis, mucoepidormoid carcinoma should be considered among the differential diagnoses and imaging with radiograph and CT should be performed to confirm the diagnosis.
对于复发性肺炎或咯血的儿童，在鉴别诊断中应考虑粘液表皮样癌，并应进行影像学检查，CT检查以确定诊断。

常发生于段支气管；CT表现为1cm至数厘米不等的类圆形或分叶状结节或肿块，50％的病例可见点状钙化；增强后均匀强化。

breathlessness:气短

lobulated：分叶状

hemoptysis： [hɪ'mɒptəsɪs] n.咳血，咯血

clubbing of fingers：杵状指

wheezing v.哮鸣;喘息

感谢Courtesy of Krishna Prasad BP, Shilpa R, Nanda K / Aster Medcity Hospital, Kerala, India

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