原发性肺淋巴瘤误诊为肺癌原因讨论

Discussion on the Causes of Pulmonary Lymphoma Misdiagnosed as Lung Cancer

目的探讨原发性肺淋巴瘤(primary pulmonary lymphoma,PPL)的诊疗特点、误诊原因及防范措施。方法回顾分析我科收治的1例误诊为肺癌的PPL的临床资料,并复习相关文献。结果患者因反复咳嗽1年余,加重10 d就诊。曾至当地医院就诊,经胸部CT检查诊断为肺癌伴肺内转移,转入我院。行胸部增强CT检查示双肺多发肿块,最大肿块位于左肺上叶,周围见磨玻璃影;纤维支气管镜检查各管腔基本通畅,未见新生物;B超检查未见全身浅表淋巴结及腹膜后淋巴结增大;查抗中性粒细胞胞浆抗体核周型及胞浆型均(-)。后经CT引导下经皮肺穿刺活检确诊为PPL,予化学治疗6个疗程,患者病情稳定。结论 PPL较为少见,易误诊。临床遇及肺部多发结节、肿块患者时,应高度警惕PPL,及时进行病理检查,以减少误诊误治。

Objective To analyze diagnosis and treatment characteristics, misdiagnosis causes of primary pulmonary lymphoma （ PPL） , and propose preventive measures. Methods Clinical data of one case of primary pulmonary lymphoma misdiagnosed as lung cancer in our hospital was retrospectively analyzed with a review of literature. Results The patient had recurrent cough more than one year, and exacerbated for 10 days. Diagnosed as having lung cancer with pulmonary metastasis through chest CT in other hospital, she was finally transferred to our hospital. Contrast chest CT showed multiple tumors in both lungs, and the largest is located in the left upper lobe, surrounded by ground-glass opacity. Fiberoptic bronchoscope was used to check every lumen, no obstruction and neoplasm were found. B-type ultrasound revealed no enlarged superficial lymph nodes and retroperitoneal lymph nodes. P-antineutrophil cytoplasmic antibody and C-antineutrophil cytoplasmic antibody were all negative. She was diagnosed with PPL by lung biopsy and pathological examination through percutaneous lung puncture. After 6 cycles of chemotherapy, the patient was in a stable condition. Conclusion PPL may be misdiagnosed easily, because it is rare in clinic. Multiple pulmonary nodules and masses should be highly suspected of PPL, and lung biopsy is significant for reducing misdiagnosis.