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DOI: 10.1055/s-0043-111237
Chirurgische Therapie von Pseudotumoren der Lunge
Surgical Treatment of Pseudotumours of the LungPublication History
Publication Date:
22 June 2017 (online)
![](https://www.thieme-connect.de/media/zblchir/201801/lookinside/thumbnails/10-1055-s-0043-111237_zbc1312-1.jpg)
Zusammenfassung
Hintergrund Der pulmonale Pseudotumor ist ein Sammelbegriff für diverse Subentitäten. Einige Subgruppen werden als intermediär maligne Tumoren betrachtet. Der Pseudotumor ist ein seltenes Krankheitsbild, wobei eine Abschätzung der Inzidenz und der Prävalenz nur schwer möglich ist.
Methode Retrospektive Analyse aller zwischen 2008 und 2015 chirurgisch therapierten Patienten mit der Diagnose eines Pseudotumors der Lunge. Primärer Endpunkt der Studie war die Darstellung der Rezidiv- bzw. Metastasierungsrate. Sekundäre Endpunkte waren die Nomenklatur, die Anamnese, die Therapieart und der perioperative Verlauf.
Ergebnisse Von 27 Patienten (63% männlich) mit einem Durchschnittsalter von 58 Jahren hatten 19 (70%) einen inflammatorischen Pseudotumor (IPT), 4 (15%) einen inflammatorisch-myofibroblastären Tumor (IMT) und jeweils 2 Patienten (7,5%) ein Pneumozytom bzw. Histiozytom. Eine präoperative pulmonale Infektion lag bei 12 (44%) Patienten vor. Die durchschnittliche Tumorgröße lag bei 2,1 cm (0,8 – 5,3 cm), die Lungenunterlappen waren mit 52% präferiert. Es wurden eine Enukleation, 20 atypische und 6 anatomische Resektionen durchgeführt. Dies erfolgte in 48% der Fälle (13/27) minimalinvasiv (VATS). Eine R0-Resektion lag bei 93% der Fälle (25/27) vor. Komplikationen traten bei 7 (26%) Patienten auf. Die Aufenthaltsdauer (Mittel 8 Tage) nach offener Resektion und VATS unterschied sich minimal (8,8 vs. 7,2 Tage). Das Follow-up lag bei 4 Jahren. In dieser Zeit entwickelte eine Patientin trotz R0-Resektion eines IMT ein Tumorrezidiv, an dem sie auch verstarb.
Schlussfolgerung Die Therapie der Wahl beim Pseudotumor ist die R0-Resektion, bevorzugt per VATS. Die meisten Pseudotumoren nehmen einen gutartigen Verlauf, wenngleich Rezidive in einem kleineren Teil (v. a. bei IMT) der Fälle möglich sind. Eine Nachbeobachtung ist bei IMT notwendig. Die Anwendung einer einheitlichen Nomenklatur und Klassifikation wäre sinnvoll.
Abstract
Introduction Pseudotumour of the lung is a collective term for various subentities. Some subgroups are considered to be intermediary malignant tumours. A pseudotumour is a rare condition, which makes it difficult to estimate its incidence and prevalence.
Methods Retrospective analysis of all surgically treated patients between 2008 and 2015 diagnosed with a pseudotumour of the lung. The primary endpoint of this study was to estimate the rates of local recurrence and metastasis. Secondary endpoints were to determine the nomenclature, medical history, treatment, and the perioperative course.
Results Out of 27 patients (10 females and 17 males) with a median age of 58 years, 19 patients (70%) had an inflammatory pseudotumour (IPT), and four patients (15%) had an inflammatory myofibroblastoma (IMT). Two patients had a pneumocytoma/histiocytoma. A preoperative pulmonary infection was present in 12 (44%) patients. The average tumour size was 2.1 cm (0.8 – 5.3 cm), with the lower pulmonary lobes being mostly affected (52%). One enucleation, 20 atypical wedge resections and six anatomical resections were performed. This was done in a minimally invasive procedure (VATS) in 48% of cases (13/27). R0 resection was achieved in 93% of cases (25/27). Complications occurred in seven (26%) patients. The difference between the duration of hospital stay (mean duration 8 days) after open resection and VATS was minimal (8.8 vs. 7.2 days). Patients were followed up over a period of 4 years, during which time only one patient developed a tumour recurrence, which led to the patientʼs death, although she had had a R0 resection of an IMT.
Conclusions The treatment of choice for pseudotumours of the lung is R0 resection, preferably with VATS. Most patients have a benign course of disease, although relapses are possible in some cases, especially in IMT. Follow-up monitoring is necessary for IMT. The application of a uniform nomenclature and classification would be a sensible approach.
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Literatur
- 1 Narla LD, Newman B, Spottswood SS. et al. Inflammatory pseudotumor. Radiographics 2003; 23: 719-729
- 2 Cerfolio RJ, Allen MS, Nascimento AG. et al. Inflammatory pseudotumors of the lung. Ann Thorac Surg 1999; 67: 933-936
- 3 Fabre D, Fadel E, Singhal S. et al. Complete resection of pulmonary inflammatory pseudotumors has excellent long-term prognosis. J Thorac Cardiovasc Surg 2009; 137: 435-440
- 4 Berardi RS, Lee SS, Chen HP. et al. Inflammatory pseudotumors of the lung. Surg Gynecol Obstet 1983; 156: 89-96
- 5 Kleinschmidt MC, Scherbaum CW, Müller T. [Inflammatory pseudotumour of the lung as a rare differential diagnosis of a pulmonary mass – a case report and overview of the literature]. Pneumologie 2010; 64: 246-248
- 6 Kaitoukov Y, Rakovich G, Trahan S. et al. Inflammatory pseudotumour of the lung. Can Respir J 2011; 18: 315-317
- 7 Matsubara O, Tan-Liu NS, Kenney RM. et al. Inflammatory pseudotumors of the lung: progression from organizing pneumonia to fibrous histiocytoma or to plasma cell granuloma in 32 cases. Hum Pathol 1988; 19: 807-814
- 8 Katenkamp K, Katenkamp D. Soft tissue tumors: new perspectives on classification and diagnosis. Dtsch Arztebl Int 2009; 106: 632-636
- 9 Passlick B, Izbicki JR, Kreusser T. et al. [Plasma cell granuloma of the lung. A rare differential diagnosis of pulmonary coin lesion]. Zentralbl Chir 1991; 116: 51-55
- 10 Melloni G, Carretta A, Ciriaco P. et al. Inflammatory pseudotumor of the lung in adults. Ann Thorac Surg 2005; 79: 426-432
- 11 Dehner LP. The enigmatic inflammatory pseudotumours: the current state of our understanding, or misunderstanding. J Pathol 2000; 192: 277-279
- 12 Gleason BC, Fletcher CD. Deep “benign” fibrous histiocytoma: clinicopathologic analysis of 69 cases of a rare tumor indicating occasional metastatic potential. Am J Surg Pathol 2008; 32: 354-362
- 13 Gleason BC, Hornick JL. Inflammatory myofibroblastic tumours: where are we now?. J Clin Pathol 2008; 61: 428-437
- 14 Coffin CM, Hornick JL, Fletcher CD. Inflammatory myofibroblastic tumor: comparison of clinicopathologic, histologic, and immunohistochemical features including ALK expression in atypical and aggressive cases. Am J Surg Pathol 2007; 31: 509-520
- 15 Morotti RA, Legman MD, Kerkar N. et al. Pediatric inflammatory myofibroblastic tumor with late metastasis to the lung: case report and review of the literature. Pediatr Dev Pathol 2005; 8: 224-229
- 16 Leuschner I. Inflammatory myofibroblastic tumor. Pathologe 2010; 31: 106-108
- 17 Rodriguez-Soto J, Colby TV, Rouse RV. A critical examination of the immunophenotype of pulmonary sclerosing hemangioma. Am J Surg Pathol 2000; 24: 442-450
- 18 Soule EH, Enriquez P. Atypical fibrous histiocytoma, malignant fibrous histiocytoma, malignant histiocytoma, and epithelioid sarcoma. A comparative study of 65 tumors. Cancer 1972; 30: 128-143
- 19 Copin MC, Gosselin BH, Ribet ME. Plasma cell granuloma of the lung: difficulties in diagnosis and prognosis. Ann Thorac Surg 1996; 61: 1477-1482
- 20 Bhagat P, Bal A, Das A. et al. Pulmonary inflammatory myofibroblastic tumor and IgG4-related inflammatory pseudotumor: a diagnostic dilemma. Virchows Arch 2013; 463: 743-747
- 21 Bhagat P, Bal A, Das A. et al. Pulmonary inflammatory myofibroblastic tumor and IgG4-related inflammatory pseudotumor: a diagnostic dilemma. Virchows Arch 2013; 463: 743-747
- 22 Fletcher CD. The evolving classification of soft tissue tumours: an update based on the new WHO classification. Histopathology 2006; 48: 3-12
- 23 Sakurai H, Hasegawa T, Watanabe S. et al. Inflammatory myofibroblastic tumor of the lung. Eur J Cardiothorac Surg 2004; 25: 155-159
- 24 Agrons GA, Rosado-de-Christenson ML, Kirejczyk WM. et al. Pulmonary inflammatory pseudotumor: radiologic features. Radiology 1998; 206: 511-518
- 25 Urschel JD, Horan TA, Unruh HW. Plasma cell granuloma of the lung. J Thorac Cardiovasc Surg 1992; 104: 870-875