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中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (5): 499-509.doi: 10.3969/j.issn.1000-6621.2019.05.007

• 论著 • 上一篇    下一篇



  1. 250013 济南,山东大学附属山东省胸科医院胸外科
  • 收稿日期:2019-01-15 出版日期:2019-05-10 发布日期:2019-05-10

Tuberculous pyothorax combined with pleural angiosarcoma:a case report and review of the literature

Bin ZHAO,Gao-feng QIAO,Feng JIN(),Cheng WANG,Lei SUN,Xiu-zhen. YANG   

  1. Department of Thoracic Surgery, Shandong Provincial Chest Hospital Affiliated to Shandong University, Ji’nan 250013, China
  • Received:2019-01-15 Online:2019-05-10 Published:2019-05-10


目的 总结分析结核性脓胸并发胸膜血管肉瘤的临床特点,提高临床诊疗水平。方法 对2016年11月山东大学附属山东省胸科医院收治的1例结核性脓胸并发胸膜血管肉瘤患者的临床表现、实验室检查结果、治疗及预后进行分析,并复习国内外文献资料。以“pleural angiosarcoma”为检索词检索PubMed数据库;以“胸膜血管肉瘤”为检索词检索万方医学网和中国知网数据库,检索时间为1995年1月至2018年11月;收集患者的一般情况、既往病史、影像学表现、病理免疫组织化学检测结果、治疗方法、预后及病程时间。结果 患者,男,56岁。因“胸闷、咳嗽超过1个月,痰中带血20d”入院,住院期间多次行胸部手术,病理诊断为结核性脓胸并发胸膜血管肉瘤。患者发病17个月后因病死亡。通过文献复习与筛选共获得相关文献31篇,包含32例胸膜血管肉瘤患者,加上本例患者共计33例;其中男23例,女10例,年龄24~87岁,平均(64.12±13.90)岁。33例患者中有结核性脓胸病史者9例,有脓胸病史者1例;有放化疗病史者2例,单纯放疗病史者1例;有粉尘接触史者1例。病灶位于右侧胸腔14例,左侧胸腔12例,双侧胸腔7例;发病时单纯胸腔积液者4例,胸膜增厚、胸膜肿物者12例,胸腔积液并发胸膜增厚、胸膜肿物者17例;明确有血胸者16例;发生转移病灶5例;CD31阳性者27例,CD34阳性者17例,Vimentin阳性者15例,Ⅷ因子相关抗原阳性者9例。33例患者均为病理确诊。治疗方法有手术(14例)、化疗(10例)、放疗(6例)、介入动脉栓塞(2例)、微波消融(1例)、胸膜固定(3例)、血管靶向药物治疗(5例)。患者病程为2个月至15年,中位时间为7个月;最终24例患者死亡,预后不详、失访和末次随访时存活者各3例。结论 胸膜血管肉瘤临床表现缺乏特异性,结核性脓胸易导致胸膜血管肉瘤的发生,当结核性脓胸患者并发不明原因的渗血性病变时,应考虑到本病的可能,防止误诊、漏诊。

关键词: 脓胸, 结核性, 血管肉瘤, 胸膜肿瘤, 共病现象, 疾病特征


Objective The clinical features of tuberculous pyothorax combined with pleural angiosarcoma were summarized and analyzed in order to improve clinical diagnosis and treatment.Methods The clinical manifestation, laboratory findings, treatment and prognosis of one case with tuberculous pyothorax combined with pleural angiosarcoma who were admitted to Shandong Provincial Chest Hospital Affiliated to Shandong University in September 2016 were reported, and the corresponding domestic and foreign literatures were reviewed and analyzed. The PubMed, Wanfang, and CNKI databases were searched by using “pleural angiosarcoma” and “pleura; angiosarcoma” as search terms and the date of retrieval was set from January 1995 to November 2018. The patient’s general condition, past medical history, imaging performance, pathological immunohistochemistry results, treatments, outcome and duration of disease were collected.Results The 56-year-old male patient complained of dyspnea, cough for more than one month, and blood-stained sputum for 20 days. The patient underwent multiple thoracotomies. The pathological diagnosis was tuberculous empyema complicated with pleural angiosarcoma. The patient died after 17 months of onset. A total of 31 articles were retrieved through literatures review. Data on 32 patients with pleural angiosarcoma were obtained. The total number of subjects was 33 cases including the case reported in this study. There were 23 males and 10 females, who aged from 24-87 years (average 64.12±13.90 years). For past medical history, 9 cases had a tuberculous pyothorax history and 1 case had a pyothorax history; 2 cases had received chemoradiotherapy and 1 case had received radiotherapy only; and 1 case had a history of dust exposure. The lesions were located in the right hemithorax in 14 cases, the left hemithorax in 12 cases, and in bilateral thorax in 7 cases. There were 4 cases with pleural fluid only, 12 cases with pleura-thicking and pleural mass, and 17 cases with both plrural fluid, pleura-thinking and pleural mass; 16 cases were confirmed with hemothorax; 5 cases deve-loped metastases; 27 cases were positive with CD31, 17 cases positive with CD34, 15 cases positive with Vimentin, and 9 cases positive with Factor Ⅷ-related antigen. The therapy methods included surgery, chemotherapy, radiotherapy, interventional arterial embolism, microwave ablation, pleural immobilization, vascular-targeted drugs. All of the 33 cases were diagnosed by pathology. The therapies included surgery (14 cases), chemotherapy (10 cases), radiotherapy (6 cases), interventional arterial embolization (2 cases), microwave ablation (1 case), pleural fixation (3 cases), and targeted drug therapy (5 cases). Duration of disease were 2 months to 15 years, with a media time of 7 months. At last, 24 patients died, 3 had unknown outcome, 3 lost were lost to follow-up, and 3 patients were still alive at the last follow-up.Conclusion The clinical manifestations of pleural angiosarcoma are not typical. Tuberculous pyothorax is high risk factor for pleural angiosarcoma. Pleural angiosarcoma should been taken into considera-tion when unexplained osmolar lesion occurs in tuberculous pyothorax.

Key words: Empyema, tuberculous, Hemangiosarcoma, Pleural neoplasms, Comorbidity, Disease attributes