Objective To improve the knowledge of pulmonary sclerosing hemangioma ( PSH)especially with bilateral multiple lesions of the lung. Methods The clinical data of 3 cases of PSH ( 1 case with bilateral multiple lesions in the lung) were analyzed, and the related literatures were reviewed. Results All of the 3 cases were females. A 22-year-old female patientwith bilateral multiple nodules in the lungs was complicated with thyroid multiple nodular goiter ( with hypothyroidism) , dysfunctional uterine bleeding ( with anemia) , nodular hyperplasia of the breast, and arteriovenous malformation over forearm. Thoracoscopicbiopsy of left lung and resection of the right pulmonary mass were performed and both the lesions were confirmed as PSH. The clinical manifestations of multiorgan diseases and the presence of PSH suggested Cowden syndrome in this patient. The other 2 cases aged 50 and 53 were asymptomatic with solitary pulmonary nodules identified incidentally. The accessory examinations for malignancies, infections, and autoimmune diseases showed no specific findings. Resection of the lesions were performed by thoracoscopic surgery and thoracotomy respectively, and the histopathological results proved to be PSH. Literature review showed that PSH typically occurred in middle-aged women without clinical symptoms and signs, often presenting as a pulmonary solitary nodule/mass identified incidentally. The differential diagnosis should include peripheral carcinoma, hamartoma, inflammatory pseudotumor and tuberculoma. Multiple PSH, which mainly presented as multiple well-defined nodules /masses of different size in the lungs, was rather rare, but easily confused with metastatic neoplasm. Lung biopsy by surgical operation was a common way to confirm the diagnosis, while FDP-PET and fine needle aspiration biopsy showed some defects. Surgical resection was an effective method of treatment, the residual lesions of multiple PSH should be monitored. Cowden syndrome may be considered if a PSH coexisting with abnormity of multiple organs such as thyoid, breast and vessels. Conclusions PSH should be considered during the differential diagnosis for solitary or multiple nodules /masses in the lung. Surgical biopsy is a common way to confirm the diagnosis. Local excision andnecessary follow-up are effective methods of treatment.
目的总结肺硬化性血管瘤临床特点、诊断及外科治疗的经验。 方法回顾性分析2008年5月至2010年3月南京医科大学第一附属医院胸心外科行手术治疗22例肺硬化性血管瘤患者的临床资料，其中男1例、女21例，发病年龄18～75（53.5±15.1）岁。22例均行手术治疗，包括开胸手术12例，胸腔镜或胸腔镜辅助小切口手术10例；肺叶切除术12例，限制性肺切除术10例。 结果肿瘤大小与症状无显著相关性（P=0.848），中央型与外周型症状发生率差异无统计学意义（P=0.35）。手术时间55～138（100.5±27.3）min，住院时间12～52（20.9±8.2）d，无手术并发症及手术死亡。随访6～42（26±16）个月，患者均生存，无肿瘤复发及转移。 结论肺硬化性血管瘤临床及影像学检查缺乏特征性，手术是治疗肺硬化性血管瘤的有效措施。