青少年肺叶内肺隔离合并肺黏液表皮样癌1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports Pub Date : 2025-04-28 DOI:10.1016/j.epsc.2025.103026

Brooklynne A.S. Dilley-Maltenfort, John Roebel, Todd Boyd, Rachael Courtney, Daniel Evans, Anne Mackow

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引用次数: 0

摘要

儿童原发性肺癌极为罕见，每100万儿童癌症诊断中仅占0.2。其中约9%为肺粘液表皮样癌（PMEC）。由于非特异性症状类似于常见的呼吸系统疾病，他们的诊断经常被推迟。一名17岁的健康男性出现发烧、咳嗽和鼻塞，并因疑似肺炎接受抗生素治疗。尽管完成了治疗，他的症状仍然存在。在接下来的一个月里，连续的胸部x光片显示持续的左下肺叶混浊伴肺不张。胸部计算机断层扫描（CT）显示左侧下叶有一个2.7厘米的非钙化肿块，伴梗阻性改变。他入院时症状加重，但静脉注射抗生素后好转，不久出院回家。我们做了一个柔性支气管镜检查钙化肿块，发现压迫后基段支气管。支气管肺泡灌洗液样本中生长有流感嗜血杆菌。择期手术切除由于保险问题推迟了几个月。在等待清除的过程中，他出现了咯血发作，但自发性消退。复查CT显示肿块轻微增大，支气管扩张加重。他接受了电视胸腔镜左下叶切除术，在此期间，我们发现了一根来自胸主动脉的全身血管，这证实了叶内肺隔离的诊断。包含肿块和隔离的肺叶被完全切除了。病理证实肺内隔离区为低级别肺黏液表皮样癌。患者于术后第3天出院，恢复正常活动，无进一步呼吸道症状。在1个月的随访中，他仍然无症状，并继续受到肿瘤小组的监视。结论持续出现呼吸道症状的儿童和青少年需要进行全面的影像学检查，以排除肺部恶性肿瘤，尽管这种疾病很少见，但仍可能发生在这一人群中。

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Intralobar pulmonary sequestration combined with pulmonary mucoepidermoid carcinoma in an adolescent: A case report

Introduction

Primary pulmonary carcinomas in children are exceedingly rare, representing only 0.2 of every 1,000,000 childhood cancer diagnoses. Approximately 9 % of them are pulmonary mucoepidermoid carcinoma (PMEC). Due to nonspecific symptoms that mimic common respiratory conditions, their diagnosis is often delayed.

Case presentation

A 17-year-old previously healthy male presented with fever, cough, and nasal congestion and was treated with antibiotics for presumed pneumonia. Despite completing treatment, his symptoms persisted. Over the following month, serial chest X-rays showed a persistent left lower lobe opacity with atelectasis. A chest computerized tomography (CT) revealed a 2.7-cm non-calcified mass in the left lower lobe with post-obstructive changes. He was admitted to our institution with worsening symptoms but improved on IV antibiotics and was discharged home shortly thereafter. We did a flexible bronchoscopy to investigate the calcified mass and found compression of the posterior basal segment bronchi. Samples of the bronchoalveolar lavage grew Haemophilus influenzae. Elective surgical resection was delayed due to insurance issues for several months. While awaiting clearance, he presented with an episode of hemoptysis, which resolved spontaneously. A repeat CT showed slight enlargement of the mass and worsening bronchiectasis. He underwent a video-assisted thoracoscopic left lower lobectomy during which we found a systemic vessel arising from the thoracic aorta, which confirmed the diagnosis of an intralobar pulmonary sequestration. The lobe containing the mass and the sequestration was completely removed. The pathology confirmed a low-grade pulmonary mucoepidermoid carcinoma (PMEC) within the intrapulmonary sequestration. The patient was discharged on postoperative day 3 and returned to normal activities without further respiratory symptoms. At 1 month of follow up he continues to be asymptomatic and remains under surveillance by the oncology team.

Conclusion

Children and adolescents with persistent respiratory symptoms require a comprehensive imaging workup to rule out pulmonary malignancies, which, although rare, can still occur in this population.

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