2024年 · 第104卷第37期

The patient, a 39-year-old male, went to the outpatient department of respiratory and critical care medicine of Qingdao Municipal Hospital on May 9, 2024 due to "pleural space occupied for 3 months". Past physical fitness. Specialist examination showed that the percussion sound was turbid in the subscapular area of the right lower lung, and the auscultation breathing sound was weaker than that on the contralateral side. The detection of carcinoembryonic antigen, neuron-specific enolase, squamous cell carcinoma antigen and respiratory pathogen nucleic acid tests were negative at admission. Chest plain scan + enhanced CT showed that an oval soft tissue density shadow was seen locally in the right pleura, and a small patchy dense shadow was seen at the edge, with clear boundaries and a size of about 60 mm ×25 mm. The enhanced scan was mildly uneven and enhanced (shown by arrows in Figure 1, A is the plain scan image and B is the enhanced image). Thoracoscopic resection of chest wall lesions was performed, and the pathology showed: (pleural mass) spindle cell tumor with clear boundary, incomplete bone shell around it (shown by arrow in Figure 2A, hematoxylin-eosin staining ×100), tumor cells were spindle-shaped and star-shaped, interstitial mucus degeneration and more collagen (shown by arrow in Figure 2B, hematoxylin-eosin staining ×100); Immunohistochemical markers showed positive expression of Vimentin and CD10 in tumor cells, partial deletion of integrase interacting molecule 1 (INI-1), and negative expression of S-100, SOX-10, WT-1, Desmin, and activator of signal transduction transcription (STAT6), which was considered as ossifying fibromyxoid tumor (OFMT). OFMT is a rare and special type of mesenchymal soft tissue tumor, which is more common in adults. It often manifests as a slow-growing painless mass with clear boundaries in clinic. It often occurs in the subcutaneous tissue or muscle of the limbs, followed by the head, neck and trunk. It is rarely reported that it occurs in the pleura. The typical pathological manifestation of OFMT is that the tumor has fibrous pseudocapsule, and discontinuous bone shell can be seen in the capsule; The tumor cells were round, oval or short fusiform, with uneven distribution and collagen or hyaline degeneration in the interstitium. Local tumor resection is the first choice for treatment. For those with tumor tissue involvement at the surgical margin, the resection should be extended to reduce the risk of recurrence or metastasis. Follow-up data showed that 3/4 patients had a good prognosis after local resection, and about 1/4 cases had local or multiple recurrences.