摘要
肺透明細胞瘤是一種罕見的腫瘤，目前透明細胞瘤的診斷還是以組織病理學為主，並且類似腎透明細胞癌的肺臟轉移。由於它的細胞來源未知，以及臨床表現兩者各有不同，近年有些學者專注於透明細胞瘤的免疫組織化學反應，但是仍未有明確的結果。 臨床醫師的鑑別診斷應包括診斷轉移性肺透明細胞瘤，良性肺透明細胞瘤和惡性肺透明細胞瘤，因為這些疾病的臨床途徑不同，治療也是不同。我們報告一個53歲男性病患，持續兩個月的輕微咳嗽，例行性胸部X-光發現在左下肺葉有一3×3公分大小的腫塊，經初步鑑別診斷，排除動靜脈畸型，建議患者接受外科完全切除，並經過病理診斷是一個肺透明細胞瘤。同時腹部斷層攝影沒有發現任何腫塊或腫瘤，免疫組織學和臨床表現似乎偏向良性肺透明細胞瘤，此病例在臺灣亦屬罕見，同時在手術後我們將它列入長期追蹤的病例。
並列摘要
Pulmonary clear cell tumor is a rare pulmonary neoplasm. The definite diagnosis of a clear cell tumor can be made only by relying on characteristic morphologic features that have a strong resemblance to renal cell carcinoma. Due to uncertain cell origins and a variable clinical presentation, some studies have focused on the immunohistochemistry of clear cell tumors by using a broad panel of polyclonal and monoclonal antibodies. The results of those methods remain uncertain. Clinicians should distinguish benign pulmonary clear cell tumors from pulmonary clear cell carcinoma and metastatic clear cell tumors with an unknown origin because of their different clinical courses and management. We report a 53-year-old man who visited to our chest clinic due to mild cough. The chest X-ray showed a well-defined homogenous mass in the left lower lung field. The pleural sonography and bronchoscopic examination revealed no significant abnormality. This patient was recommended to undergo a video-assisted minithoracotomy in order to reach a definitive diagnosis. The resected tumor microscopic findings showed nodules of tumor cells separated by sinusoidal vessels containing abundant intracytoplasmic glycogen, which was positive for periodic acid-Schiff stain. The immunoreactivity showed protein HMB 45 (+), S-100(-), cytokeratin(-), and NSE(-), which supported the diagnosis. There was no evidence of a renal mass or other abdominal metastasis after a renal sonography and computed tomographic scanning review.
延伸閱讀
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