肺浸润性黏液腺癌六例误诊分析

Misdiagnosis Analysis of Six Cases of Pulmonary Invasive Mucinous Adenocarcinoma

目的探讨肺浸润性黏液腺癌(pulmonary invasive mucinous adenocarcinoma,PIMA)的临床特点及误诊原因,以减少临床误诊的发生。方法回顾性分析2016年5月—2018年12月我院收治的6例曾被误诊的PIMA患者资料。结果6例中误诊为肺结核、重症肺炎各2例,肺脓肿及肺炎合并支气管扩张各1例,误诊时间2周~2年。临床表现为发热、咳嗽、咳痰3例(伴呼吸衰竭2例、咳白色泡沫痰1例),咳嗽、咳痰伴胸痛1例,气短、呼吸困难1例,无症状1例。胸部CT表现为双肺弥漫型病变4例,孤立型病变2例。3例由CT引导下经皮肺穿刺病理检查确诊,2例由B超引导下经皮肺穿刺病理检查确诊,1例由胸腔穿刺病理检查确诊。6例确诊后给予手术切除治疗、化疗、靶向治疗各1例,放弃治疗2例,转院1例。化疗者随访1年,仍在治疗中,病情相对稳定;靶向治疗者随访3个月,病情基本稳定;手术切除者随访2年,病情平稳,无复发;转院者失访;放弃治疗者1月余后死亡。结论PIMA临床表现无特异性,影像学表现多样,当遇到胸部CT检查提示存在实变合并支气管充气征的难治性或无反应肺炎,以及存在囊液性或空泡型卫星灶患者时应考虑到PIMA可能,必要时可行穿刺活检,以避免或减少误诊。

Objective To investigate the clinical characteristics and misdiagnosis causes of pulmonary invasive mucinous adenocarcinoma(PIMA),so as to reduce the incidence of misdiagnosis in clinical settings.Methods Data of 6 patients misdiagnosed as PIMA who were admitted to our hospital from May 2016 to December 2018 were retrospectively analyzed.Results Among the 6 cases,2 cases were misdiagnosed as tuberculosis,2 cases as severe pneumonia,1 case as pulmonary abscess and 1 case as pneumonia combined with bronchiectasis.And the duration of misdiagnose was 2 weeks to 2 years.The clinical manifestations included fever,cough and expectoration in 3 cases(2 cases with respiratory failure and 1 case with white foam sputum),cough and expectoration with chest pain in 1 case,shortness of breath and dyspnea in 1 case,and no symptoms in 1 case.Chest CT findings revealed double lung diffuse lesions in 4 cases,and isolated lesions were found in 2 cases.Three cases were confirmed by CT guided percutaneous lung puncture for pathological examination,2 cases were confirmed by B-ultrasound guided percutaneous lung puncture for pathological examination,and 1 case was confirmed by thoracic puncture for pathological examination.After diagnosis,6 cases were given surgical resection,2 cases underwent chemotherapy,2 undergoing targeted therapy,2 cases declined to receive treatment,and 1 case was transferred to another hospital.The patients reveiving chemotherapy were followed up for 1 year,and are still under treatment with relatively stable condition.The patients receiving targeted therapy were followed up for 3 months and their condition was basically stable.The patients undergoing surgery were followed up for 2 years with stable condition and no recurrence.The transferee was lost to follow-up.Those who gave up treatment died more than a month later.Conclusion PIMA has no specific clinical manifestations but diverse imaging manifestations.When patients have refractory or unresponsive pneumonia with chest CT examination suggesting consolidation combined with bronchoinflation,or with cystic fluid or vacuolar satellite foci,PIMA should be considered,and puncture biopsy is feasible if necessary to avoid or reduce misdiagnosis.