临床影像酷似肺肿瘤的隐球菌病临床病理分析——附10例报告

Clinical and pathological analysis of cryptococcosis resembling lung tumor on clinical imaging--A report of 10 cases

目的:探讨肺隐球菌病(PC)的临床病理特征、诊断、鉴别诊断及临床误诊原因。方法:回顾性分析10例PC的病理和临床资料,并复习相关文献。结果:10例肺隐球菌病中男性6例,女性4例,年龄43~67岁,中位年龄56岁。首发症状常为咳嗽、咳痰、胸痛和发热。影像学检查:5例显示团片状影,4例呈孤立性结节影,1例为混合病变,伴毛刺征及晕征等,术前8例考虑为肺癌,2例考虑特殊感染,无1例初诊为PC。后经手术病理证实10例均为肺隐球菌病。大体切面呈灰白色或灰褐色的瘤样肿块,镜下可见8例有多核巨细胞肉芽肿形成伴大量炎细胞浸润,2例病灶内肺泡结构破坏,明显纤维化;特殊染色显示巨噬细胞胞质及肺泡腔中可见具有诊断意义的圆形空泡状隐球菌孢子。结论:PC的临床及影像学表现不特异,病理表现复杂多样,容易误诊为肺癌、结核及结节病等疾病,其诊断主要组织学形态和特殊染色,术前行经皮穿刺肺活检的诊断方法应给予足够重视。

Objective: To investigate the clinicopathologic features,diagnosis, differential diagnosis and clinical misdiagnosis of pulmonic cryptococcosis(PC). Methods: The pathological and clinical data of 10 cases of PC were analyzed retrospectively, and the related literatures were reviewed. Results: Among the 10 cases of pulmonary cryptococcosis, 6 were male, 4 were female, the age was 43-67 years old, the median age was 56 years old. The first symptoms are usually cough, sputum, chest pain, and fever. Imaging examination: 5 cases showed Patchy Mass, 4 cases showed solitary nodule, 1 case was mixed lesion, with burr and Halo Sign, 8 cases were considered lung cancer before operation, 2 cases were considered special infection, no case was first diagnosed as PC. All 10 cases were proved to be pulmonary cryptococcosis by operation and pathology. There were 8 cases of multinucleated giant Cell Granuloma with a lot of inflammatory cells infiltration. 2 cases of Alveolar Structure Destruction, obvious fibrosis;Special staining showed Cryptococcus vesicular spores in Cytoplasm of macrophages and Alveoli with diagnostic significance. Conclusions: The clinical and imaging manifestations of PC were not specific, the pathological manifestations were complicated and varied, and it was easy to be misdiagnosed as lung cancer, tuberculosis and sarcoidosis, importance should be attached to the diagnostic method of percutaneous lung biopsy before operation.