肺组织胞浆菌病CT表现及骨髓病理特征

CT manifestations and bone marrow pathological features of pulmonary histoplasmosis

目的观察肺组织胞浆菌病(HP)影像学及临床病理学表现。方法分析14例经病理确诊肺HP并接受抗真菌治疗患者的临床、胸部CT和病理学资料。14例均接受经支气管肺活组织检查(TBLB)、骨髓穿刺苏木精-伊红(HE)染色、过碘酸希夫(PAS)染色、六胺银(GMS)染色及免疫组织化学检测,其中11例接受支气管肺泡灌洗(BAL)检查及支气管肺泡灌洗液(BALF)细菌培养。记录患者腹部及体表淋巴结超声检查结果。结果14例中,12例有流感样症状,2例无症状。胸部CT显示1例结节型、13例混合型,表现为肺内多发结节、渗出及实变,部分结节伴空洞,增强后结节轻度强化;3例伴淋巴结肿大。TBLB检查示支气管及肺泡炎症,BALF细菌培养均阴性。骨髓HE染色均见组织细胞增生,肉芽肿形成;PAS染色均见菌丝和孢子呈品红色;GMS染色均见菌丝和孢子呈黑褐色;免疫组织化学CD68表达(+)示吞噬病菌的细胞为巨噬细胞。经抗真菌治疗后肺内病灶均明显吸收。结论肺HP的CT表现具有一定特征性,结合临床及流行病史有助于诊断。

Objective To observe the imaging and clinico-pathological manifestations of pulmonary histoplasmosis(HP).Methods Data of 14 patients with pathologically diagnosed lung HP and received antifungal therapy were analyzed.All patients underwent transbronchial lung biopsy(TBLB),bone marrow biopsy and bone marrow hematoxylin and eosin(HE)staining,periodic acid Schiff(PAS)staining,gomori methenamine silver(GMS)staining and immunohistochemical test,while 11 patients underwent broncho alveolar lavage(BAL)and broncho alveolar lavage fluid(BALF)bacteria culture.Ultrasonography results of abdominal and superficial lymph nodes were recorded.Results Among 14 patients,12 had influenza-like symptoms and 2 had no symptom.Chest CT showed that 1 case of nodular type and 13 cases of mixed type,with multiple pulmonary nodules,exudation and consolidation,some nodules with cavities and all nodules slightly enhanced.Enlarged lymph nodes were observed in 3 cases.Bronchial and alveolar inflammation were showed with TBLB examination,but results of BALF bacterial culture were all negative.HE staining of bone marrow showed histiocytic hyperplasia and granuloma formation.PAS staining all showed magenta mycelia and spores.GMS staining all showed dark brown mycelia and spores.Immunohistochemical CD68 expression(+)indicated macrophages swallowed histoplasmas.The effect of antifungal therapy in all patients was obvious,and intrapulmonary lesions were generally absorbed.Conclusion CT manifestations of pulmonary HP had certain characteristics,and combination of clinical and epidemic history was helpful to diagnosis.