肺结核合并肺曲霉菌感染的临床病理学分析

Clinical Pathological Analysis of Pulmonary Tuberculosis Accompanied with Aspergillosis Infection

目的:探讨肺结核合并肺曲霉菌感染的临床病理学特征、诊断及其鉴别诊断。方法:回顾分析5例肺结核合并肺曲霉菌感染患者的临床资料。对送检患者的组织标本进行常规石蜡切片、苏木精-伊红染色及高碘酸-希夫(periodic acid-Schiff,PAS)和六胺银染色,在肉眼及光镜下观察。结果:5例患者中,1例有陈旧性肺结核病史,痰培养见曲霉菌生长,2例痰涂片见抗酸杆菌阳性。CT示,左上肺空洞型肺结核2例,两肺散在支气管扩张伴感染1例,两上肺及左下肺背段见多发斑片状高密度影及纤维条索影且可见柱状扩张支气管及含气透亮区1例。光镜下观察可见,2例有上皮样肉芽肿形成,2例有灶状凝固性坏死,1例有脓肿及彻底的凝固性坏死。5例肺组织标本用苏木精-伊红染色均见大量真菌孢子,假菌丝呈45度角分枝,并有横隔;用PAS和六胺银染色可见真菌孢子、假菌丝均阳性;抗酸染色检查中4例见结核分枝杆菌。因此,确诊为肺结核合并肺曲霉菌感染。结论:肺结核患者常继发肺曲霉菌感染,临床诊断须结合影像学、病理学、痰涂片及细菌培养等检查,其中病理组织学检查更具确诊优势。

Objective：To investigate the clinical pathological features and differential diagnosis of pulmonary tuberculosis accompanied with aspergillosis infection.Methods：Clinical and pathological data of five patients with pulmonary tuberculosis accompanied with aspergillosis infection was reviewed.The tissue sections of the patients were observed after hematoxylin eosin and specific staining.Results： All of five patients were male,aged from 29 to 75 years.Among these patients,one case had the history of pulmonary tuberculosis;culture of the sputum showed growth of aspergillosis.The sputum smear of two cases was positive for acid-fast bacilli.CT examination showed two cases had cavities in the upside of left lung;one case had bronchiectasis accompanied with infection in both lungs;one patient showed multiple spotted high density shadow,cord-like shadow,dilated bronchus and gassy lucent area in superior lobe of both lungs and dorsal segment of left lower lobe.Under the microscope,epithelioid granuloma formed in two cases;two cases had focal coagulation necrosis;one case had abscess and cheesy necrosis.A great quantity of fungal spores and pseudohypha at 45 degree angle with transverse septa were seen.Spores and hypha looked prunosus after PAS staining and looked brownish-black after silver staining,but mycobacterium tuberculosis looked red in acid fast staining（four of five cases were positive）.Pathological diagnosis were consistent with pulmonary tuberculosis accompanied with aspergillomycosis.Conclusions： Aspergillomycosis usually accompanied with pulmonary tuberculosis.During the process of clinical diagnosis,doctor should combine the imaging findings,pathology,spit smear and bacterial culture,while pathological tissue examination is important for final diagnosis.