1 case of primary lung slip membrane sarcoma

Case male, 45 years old, mainly due to "cough cough ingepsis, sputum with blood for more than 70 days" was admitted to hospitalPhysical examination: chest symmetry, no deformity, two lungs clear, double lung breathing sound coarse, right lung can smell and whering, left lung (-)Multi-layer spiral CT scan show: right lung lower leaf block-like soft tissue density mass, size of about 8.3 cm x 6.4 cm x 6.9 cm, closely related to the pleural, light leaf, tumor front and outer edge visible knots, edge no burrs The lower right lung bronchial tube is blocked by pressure, the middle lobe is not clearly affected, a small amount of chest fluid on the right side, the enhanced scanning lump is patchy, mesh-like reinforcement, the inner visible spot-like no/low-reinforcement area, the visible swollen lymph nodesCTdiagnosisresults: lung cancer around the lower loin of the right lung is associated with the metastasis of the lymph nodesCT-guided puncture biopsy, pathological cues: "the alveolar cavity can be seen gobbling cells, part of the alveoli widening, inflammatory cells immersion, and can be seen in a bundle of shuttle-shaped cells." Surgical procedure and pathology: the patient in the whole hemp downstream right lung in the lower lobe removal and vertical lymph node cleaning, chest cavity mirror detection chest cavity visible full chest membrane adhesion, the swelling is a long cylindrical convex upper leaf opening, with the trachea wall no obvious adhesion, complete removal of the lower and middle lobes and clean the apparently swollen group 2, 4, 7 groups of lymph nodesPostoperative pathological diagnosis "single-phase slide carat sarcoma, the 2nd, 4th and 7th group of lymph nodes did not see metastasis"immunegrouping results are: EMA (-), Vimentin (-), Ki-67 (-10%), CK (-), Bcl-2 (-), CD34 (-), SMA (-), Desmin (-)Figure 1 vertical window show: the right lung lower leaf uniform density soft tissue lump, its outer edge can be seen nipple-like soft tissue protrusion, the right chest cavity a small amount of fluidFigure 2 Enhanced scanning: uneven reinforcement of soft tissue lumps in the lower loin of the right lungFigure 3 The coronal position shows that the soft tissue lumps of the lower loin of the right lung are not uniformly reinforcedFigure 4 Coronary position: split thickening between the leaves adjacent to the lump of the lower right lung, and the outer edge nodule-like protrusionFigure 5 The conventional pathological form of tumor is consistent with single-phase sliding membrane sarcomaFigure 6 Immunohiscizing shows Vimentin discussion glioblastoma is a rare soft tissue malignant tumor, accounting for about 5% to 10% of all soft tissue sarcoma, more occur in the adjacent parts of the limbs, even can occur in other parts of the joint without the slide membrane, such as head and neck, chest wall, lung, vertical, heart, abdominal wall, kidneys and so on Pulmonary primary glioblastoma is rare and highly invasive, accounting for only 0.5% of lung primary malignancies Pulmonary caricosinoma belongs to a type of sarcoma, high degree of malignancy, faster growth, mostly limited aggression and blood transfer, very little lymph node metastasis Primary lung slip membrane sarcoma has no gender difference, unlike other lung primary malignancies, the disease is not related to smoking WHO divided it into bipolar, monophase shuttle cell, monophase epithelial cell type and low differentiation type according to the histological differentiation characteristics of sliding carnivorous sarcoma Immunized Vimentin, CK, EMA, CD-99, Bcl-2 and other positive, CD34, S-100 negative Cytogenetics and molecular genetics show that about 90% of sliding-film sarcoma have characteristic chromosomal translocation t (x:18) (p11:q11), resulting in the fusion of the SYT gene in chromosome 18 with the X chromosome SSX gene The clinical manifestations of primary sliding caricoma are not specific, including chest pain, cough, dyspnea and hemorrhage, other rare symptoms and signs of pleurisy pain, chest heavyness, shoulder pain, fever, blood chest and spontaneous gas chest Primary glioblastoma imaging performance is not specific, often need to be identified with the pleural or lung source of a variety of primary, secondary tumors, such as lung cancer, pleural-pulmonary metastasis, other lung or pleural primary sarcoma, pleural limitation fibrosis tumors, malignant mesothelioma, etc primary slide-film sarcoma plurisced body is shown as a clear bordering lump, which can be the lung or pleural base, often accompanied by thoracic fluid CT is shown as uneven intrapulmonary substantive block shadow, irregular form or round-like, leaves are not obvious, boundary is clear, within can be seen necrosis, liquefied, bleeding, etc., the lesions are unevenly reinforced, often chest attack to the thoracic fluid, there are few lung doors or vertical lymph nodes transfer Although carbide sarcoma at the joint site often has calcification, primary slide-film sarcoma is usually non-calcified In this case, the lesions were lumpy lumps of shallow lobes in the lungs, uneven density, uneven reinforcement, compression of the lower loal bronchial tube of the right lung, adjacent to the chest membrane aggression, the mass performance was consistent with the literature reports; The main treatment method of sliding membrane sarcoma is surgical excision, which makes the surgical cut negative, and assists in the release of chemotherapy, which is an important measure to prevent the recurrence of after surgery in short, primary glioblastoma is a rare tumor, because its clinical and imaging performance is not specific, so easy to misdiagnose, diagnosis needs to be combined with pathology, immunomycarditization and cytogenetic test results