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1 病例介绍患者,李某,女,67岁。因咳嗽伴左胸剧痛一月余而入院治疗。体格检查:发育正常,营养较差,胸廓对称,肝脾肋下未触及。CT示:左肺下叶心影旁见一巨大软组织块影,呈尖圆形,边界光滑,大小约8cm×18cm,密度均匀。CT值41～80Hu,右下肺见形态不整斑影,纵隔未见肿大淋巴结。患者有慢性支气管炎和肺气肿病史。临床诊断:左肺下叶占位病变。行手术切除,术中见肿物占据整个左肺下叶,斜裂处部分粘连,与膈肌粘连。病理检查,见左肺下叶,切开可见一肿物大小约12cm×10cm×8cm,实性,边界清,质地细腻,灰黄色。镜下显示由分化较低腺癌与恶性淋巴瘤两种成分构成。腺癌显示大量椭圆形细胞成团块聚集,偶见腺管样结构,其细胞明显间变,核分裂多见。淋巴瘤显示弥漫增生之淋巴细胞,细胞小,呈一致性,细
1 case presentation patient, Lee, female, 67 years old. Cough with left chest pain for more than a month and admitted to hospital. Physical examination: normal development, poor nutrition, thoracic symmetry, liver and spleen did not touch the ribs. CT showed a huge soft tissue shadow next to the heart lobe of the left lower lobe, which was pointed and rounded, with a smooth boundary, about 8cm×18cm in size, and uniform in density. CT value 41 ~ 80Hu, the right lower lung see morphological spots, no enlargement of the mediastinal lymph nodes. The patient had a history of chronic bronchitis and emphysema. Clinical diagnosis: left lung lobe lesion. Surgical resection, intraoperative see tumor occupy the entire left lower lobe, oblique cracks in some adhesions, and diaphragm adhesion. For pathological examination, see the left lower lobe of the lung. The size of a tumor is approximately 12cm×10cm×8cm. The solid is clear, the boundary is clear, and the texture is delicate and grayish yellow. Microscopically, it consists of two components that are poorly differentiated adenocarcinoma and malignant lymphoma. Adenocarcinoma showed a large number of oval cells clustered together, occasionally seen gland-like structure, the cells were significantly interspersed, more common nuclear division. Lymphoma shows diffuse proliferation of lymphocytes, cells are small, showing consistency, fine