非空洞肺癌合并癌旁曲霉病1例并21例文献分析

Non-cavitary lung cancer complicated with pulmonary aspergillosis:one case report and literature review of 21cases

目的掌握非空洞肺癌合并癌旁曲霉病的临床特征、诊断方法和治疗。方法对1例肺癌合并局部侵袭性曲霉病患者的临床表现、纤维支气管镜(纤支镜)检查和病理诊断进行分析;回顾1984—2011年国内外非空洞肺癌合并癌旁曲霉病的文献资料,总结患者临床特点。结果该例患者纤支镜活检病理示曲霉感染,伊曲康唑治疗后复查纤支镜活检病理疑似合并肺鳞癌,行肺叶切除术后确诊肺鳞癌合并肺曲霉病。文献回顾纳入21例临床病例报告,显示非空洞肺癌同时可合并原位曲霉感染临床较少见且易漏诊。结论非空洞肺癌患者确诊同时可合并癌旁曲霉感染;对于没有真菌易感因素的肺曲霉病患者,要考虑合并肺癌的可能;治疗肺癌的同时,需关注癌旁真菌感染的治疗及归转。

Objective To understand the clinical manifestations, diagnosis and treatment of non-cavitary lung cancer complicated with pulmonary aspergillosis. Methods The clinical manifestations, bronchoscopic biopsy and histological analysis were reviewed in one case of non-cavitary lung cancer complicated with pulmonary aspergillosis. The similar case reports during the period from 1984 to 2011 in the world were reviewed and analyzed. A total of 21 cases were included and reviewed with the relevant clinical data. Results Bronchoscopic biopsy results revealed Aspergillus hyphae in the tissue. Bronchoscopic examination was performed a week after antifungal therapy with itraconazole. Further pathologic results found suspicious squamous cell carcinoma. Pulmonary lobectomy was done. Lung squamous carcinoma and aspergillosis were confirmed. The subsequent literature review of 21 cases showed that non-cavitary lung cancer complicated with pulmonary aspergillosis was rarely reported and maybe underdiagnosed. Conclusions Non-cavitary lung cancer patients may be complicated with pulmonary aspergillosis at the same time if untreated. We should raise the suspicion of malignancy in aspergillosis patients without strong risk factors for fungal disease. We should keep an eye on the treatment of aspergillosis while treating patients with lung cancer.