细支气管肺泡细胞癌文献复习

Document review of bronchioalveolar carcinoma

目的提高对细支气管肺泡癌临床表现及影像学多样性的认识。方法分析2012年7月收治的1例细支气管肺泡癌患者的临床资料及诊治经过,文献复习。结果因发热、咳嗽、咳痰1月,呼吸困难1周于2012-7-26住院。肺部可闻及velcro啰音,胸部CT为双肺散在分布的小结节,斑片模糊影,可见充气支气管征,血气分析为Ⅰ型呼吸衰竭,经甲强龙及无创呼吸机治疗,患者呼吸困难明显减轻,呼衰减轻。后经皮肺活检病理检查为肺泡细胞癌。EGFR基因检测外显子EXON 21突变。化疗效果欠佳,给予吉非替尼治疗,患者气短消失,肺部Velcro消失,肺部病变明显吸收。结论细支气管肺泡癌临床表现缺乏特异性,影像学呈多样性,极易误诊,应提高对本病的认识,可从痰病理学检查或经皮肺活检明确诊断。

Objective To promote the recognition of manifestation and imaging variety of bronchioalveolar carcinoma. Methods The clinical date of 1 patient with bronchioalveolar carcinoma in July 2012 were retrospective-ly analyzed and reviewed. Results A patient hospitalized on July 26, 2012, because of fever, cough and sputum for 1 month, and dyspnea for 1 week. Velcro rale was auscultated in both lungs. Chest CT showed small nodules, diffuse opacity, consolidation shadows and air bronchogram in both lungs. Blood gas analysis showed typeⅠrespiratory fail-ure. The patient was given methylprednisolone sodium succinate for injection and BiPAP noninvasive ventilation. The patient＇s dyspnea alleviated, and type Ⅰ respiratory failure was corrected. Latterly, pulmonary lesion was diagnosed as bronchioalveolar carcinoma by CT-guide percutaneous lung biopsy. Exon 21 mutation of EGFR was detected in bi-opsy specimen. The patient was treated with chemotherapy, but the curative effect was not satisfying. The patient took gefitinib （250mg） every day, and her breath shortness and lung velcro rale disappeared and pulmonary lesion turned better. Conclusion Because of no specific clinical manifestation and verity of chest CT scanning, bronchio-alveolar carcinoma can be misdiagnosed easily, the recognition for bronchioalveolar carcinoma should be promoted. Percutaneous lung biopsy and sputum cell pathological examination are more valuable in the diagnosis of bronchioalve-olar carcinoma.