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临床资料患者,男,50岁。咳嗽、咳痰2个月,痰中带血5 d。查体:双肺呼吸音清晰,未闻及干、湿啰音。胸部CT示:左肺上叶有占位性病变,大小约64 mm×46 mm,边缘分叶,内部有点状钙化;增强CT扫描:有明显的不均匀强化,邻近支气管管腔狭窄,左肺上叶肺动脉狭窄阻塞,见图1。支气管镜示:左肺舌叶口内可见一外突型肿物,堵塞一侧分支,余各级支气管光滑通畅。支气管镜病理检查未见癌组织。左肺穿刺活检示:恶性肿瘤,免疫组化检查示:CD138蛋白(+),MuM1蛋白(+),平滑肌肌动蛋白CD79a少数(+),核抗原Ki-67:30%～40%(+);CD56蛋白、细胞角蛋白CK8/18、鼠
Clinical data patients, male, 50 years old. Cough, expectoration for 2 months, sputum blood 5 d. Examination: lung breath sounds clear, unheard of and dry, wet rales. Chest CT showed: the left upper lobe occupying lesions, the size of about 64 mm × 46 mm, the edge of the leaves, a bit of internal calcification; enhanced CT scan: there is significant heterogeneous enhancement, adjacent to bronchial stenosis, the left lung Pulmonary artery stenosis, see Figure 1. Bronchoscopy: left lung lobes visible a protruding type of tumor, blocking the side of the branch, more than all levels of bronchial smooth. No pathological bronchoscopy cancer. Left lung biopsy showed: malignant tumor, immunohistochemical examination showed: CD138 protein (+), MuM1 protein (+), smooth muscle actin CD79a minority (+), nuclear antigen Ki- 67: 30% -40% ); CD56 protein, cytokeratin CK8 / 18, murine