临床酷似肺癌的肺隐球菌病12例临床病理分析

Pulmonary cryptococcosis mimicking carcinoma of the lung: a clinicopathologic analysis of 12 cases

目的 探讨肺隐球菌病 (PC)的病理、临床特点及术前误诊原因。方法 回顾性分析 12例PC的病理和临床资料。结果 12例PC多见于中年男性 ,首发症状常为咳嗽、痰血和发热 ,5例有慢性病史。X线胸片示病灶位于左肺 5例 ,右肺 7例 ;病灶直径≤ 3cm 2例 ,3— 5cm 3例 ,5— 7cm 5例 ,>7cm 2例 ;10例为单个块影或球形阴影 ,2例分别为多个类圆形结节影和斑片状影。胸部CT扫描 7例为密度不均的团块或结节影 ,4例考虑为肺癌 ,1例为感染灶 ,2例不能确定性质 ;ECT67Ga肺显像 5例 ,均为高度异常浓聚灶 ,提示肺癌 ;临床初诊和术前诊断多误诊为肺癌或肺肿瘤 ,无 1例初诊为PC。后经手术病理证实 10例 ,痰菌明确 2例。病理学检查 8例有隐球菌肉芽肿形成 ,2例分别为含菌的纤维结缔组织病灶和胶样病灶 ;肉眼标本质硬灰白无包膜。结论 PC的临床和影像学表现缺乏特征性 ,肉眼标本与肺癌不易区别 ,诊断有赖于病理组织学检查 ;

Objective To investigate the clinicopathologic features of pulmonary cryptococcosis (PC) and its underlying reasons of preoperative misdiagnosis. Methods Clinical data and pathologic changes were analyzed in 12 cases of PC. Results Majority of the patients was middle-aged male. The early symptoms were cough, phlegm with blood and fever. Five cases had a history of chronic diseases. X-ray examination showed that the lesion located in left lung in 5 cases and right lung in 7 cases. Size of the lesions was ≤3 cm in diameter in 2 cases, 3-5 cm in 3 cases, 5-7 cm in 5 cases and >7 cm in 2 cases. Single round mass was found in 10 cases and other 2 showed multi-spherical nodules or smear-like shadows in the lung. Eight of the 12 patients had'hair stab'appearance and 2 had cavities on chest X-ray pictures. CT scanning was performed in 7 patients and showed irregular masses or nodules, considered as lung cancer in 4 cases. 67Ga ECT imaging (5 cases) demonstrated abnormal high-density masses, implying lung cancer. Clinical diagnosis before operation was lung cancers or lung tumors in all cases. Pathologic examination showed that the gross appearance of the specimen was stiffen, gray in color and without capsule , and microscopically, cryptococcosis granuloma formation was found in 8 of 10 cases, and other 2 showed fibrosis with fungi and colloidal degeneration. The final pathological diagnosis was obtained in 10 cases after operation, and other 2 were further confirmed by fungi culture of the sputum. Conclusions PC has not had any specific clinical manifestation and image finding. Gross appearance of the specimen can not be differentiated from that of lung cancer. The correct diagnosis relies on histopathologic examination. It is suggested that more methods for the diagnosis without operation need to be investigated.