Pulmonary Amyloidoma Coexisting with Lung Adenocarcinoma: A Case Report and Literature Review

肺部類澱粉瘤合併肺腺癌：個案報告與文獻回顧

蘇柏嵐(Po-Lan Su) ； 朱彰堯(Chang-Yao Chu) ； 顏經洲(Jing-Jou Yan) ； 張漢煜(Han-Yu Chang)

《胸腔醫學》 30卷5期 (2015/10) Pp. 286-292

摘要

類澱粉沉積症於病理學切片上會呈現纖維狀蛋白以β摺疊的方式沉積，一般可以使用剛果紅染色後在偏光顯微鏡下呈現黃綠折射來診斷。臨床上表現取決於沉積的器官位置，以肺部為例，類澱粉的沉積可以區分為四大類。在肺實質以瀰漫性間質沉積或結節沉積、在氣管以黏膜下腫瘤或環狀沉積。其中結節沉積又被稱做是類澱粉瘤，常見於60～70歲病患，男女比大約1:1，大多數是良性變化，可能以單一或事多發結節來表現。在影像分析上大多邊緣清晰，大小分布於0.4～15公分不等。多發性結節通常會合併咳嗽、血痰或是肋膜疼痛的情況。在病理切片下有時會合併有鈣化或軟骨生成的情形。曾有文獻指出類澱粉瘤與乾燥症以及邊緣區淋巴瘤有相關性，也容易在正子造影過程會呈現類惡性腫瘤的表現。目前沒有文獻指出與肺腺癌有相關性。

關鍵字

多發性肋膜下類澱粉瘤

並列摘要

Amyloidosis is characterized histopathologically by tissue infiltration with fibrillar protein with a β-sheet structural conformation. Clinical manifestations vary depending upon the type of amyloid and the distribution of deposition. Pulmonary amyloidosis may be localized to the respiratory tract or be part of a widespread process involving many organs. Primary pulmonary amyloidosis is classified into 4 major patterns, including parenchymal amyloidosis with a diffuse interstitial or nodular pattern, and tracheobronchial amyloidosis with submucosal plaques or luminal tumor-like masses. Pulmonary nodular amyloidosis, which is also referred to as ＂amyloidomas,＂ develops mainly in the 6^(th) to 7^(th) decade without a gender predominance; it usually has a benign clinical course, and grows slowly. The nodules are, for the most part, rounded, sharply delimited, and located peripherally, with sizes ranging from 0.4 cm to 15 cm. The existence of multiple nodules is associated with cough, hemoptysis, and pleuritic pain. Calcification, and metaplastic bone or cartilage formation is usually found. Increased FDG uptake and an association with Sjögren's syndrome and pulmonary marginal zone lymphoma have been reported. No association with lung adenocarcinoma was reported in previous case series.

並列關鍵字

amyloidosis