非HIV肺隐球菌病组织病理与CT影像比对

Comparison of computed tomography images and histopathology of non-HIV pulmonary cryptococcosis

目的:通过对肺隐球菌病CT影像与组织病理的比对分析,提高对肺隐球菌的认识和诊断的准确性。方法:本研究纳入复旦大学附属华山医院2010年1月至2019年12月经胸部CT发现、视频辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)切除、术后病理确诊的53例肺隐球菌病患者。通过比对胸部CT和组织病理图像特点,分析引起肺隐球菌影像学改变的组织学基础。结果:胸部CT显示在53例肺隐球菌病灶中,49例结节状、3例斑片状、1例斑片结节混合影;49例病灶不超过3 cm,其中24例小于1cm;45例病灶距胸膜不超过1cm;50例为高密度或高低密度混杂影,3例为磨玻璃影;18例病灶内见空泡,4例见透亮区,4例见支气管充气征,3例见空洞;24例病灶边缘见毛刺,13例边缘呈分叶状;31例病灶与周围肺组织分界清,22例与周围组织分界不清,出现晕征/磨玻璃影、血管集束和胸膜凹陷。组织学特点:53例肺隐球菌病灶中49例为肉芽肿性炎症,4例为非肉芽肿性组织细胞反应;肉芽肿病变中12例有炎性坏死、3例空洞形成、3例脓肿和1例隐球菌湖形成,8例见残留肺泡、3例见扩张支气管;病灶边缘机化13例,纤维包裹及炎性增宽肺泡隔各4例;病灶周围见出血及水肿18例,血管扩张、纠集和穿透共15例,胸膜牵拉10例。结论:肺隐球菌病的各种组织学特点导致了相应的影像学改变。了解引起肺隐球菌感染CT影像改变的组织学,结合穿刺标本的组织学检查可避免过诊断为恶性肿瘤,减少不必要的手术治疗。

Objective:To improve the recognition and diagnostic accuracy of pulmonary cryptococcosis through the comparative analysis of CT images and histopathology.Methods:A total of 53 patients with pulmonary cryptococcosis detected by chest CT scan,resected through video-assisted thoracoscopic surgery(VATS),and diagnosed by postoperative pathological analysis were included in our study from January 2010 to December 2019 in Huashan Hospital,Fudan University.By comparing the characteristics of CT and pathological images,the histological basis of the CT imaging changes of pulmonary cryptococcosis was analyzed.Results:The CT findings of pulmonary cryptococcosis were nodules in 49 cases,patches in 3 cases,mixed patchy and nodule in 1 case.The size of the lesions in 49 cases were less than 3 cm,of which 24 cases were less than 1 cm.In 45 cases,the distance from the lesion to the pleura was less than 1 cm.Fifty cases were high density or high-and low-density mixed shadows,and 3 cases were ground glass shadows.Vacuoles was found in 18 cases,lucid area,and air bronchogram sign in 4 cases,and cavitation in 3 cases,respectively.Twenty-four cases showed spiculation on the edge,and 13 cases showed lobulated edges.In 31 cases,the lesion was clearly demarcated from the surrounding lung tissue,and in 22 cases,the lesion was not clearly demarcated from the surrounding tissue,with halo sign/ground glass opacities,vascular cluster,and pleural indentation.Histological examination found that 49 cases of pulmonary cryptococcal lesions showed granulomatous inflammation,and 4 cases showed non-granulomatous histiocytic reaction.In the granulomatous lesions,there were 12 cases with coagulative necrosis,3 cases with cavitation,3 cases with abscess-formation and 1 case with“cryptococcus lake”-formation,8 cases with residual alveoli and 3 cases with dilated bronchus inside lesions;13 cases with organizing pneumonia,4 cases with fibrous encapsulation and 4 cases with widened alveolar septum due to inflammation were found in the edge of lesions,respectively.Hemorrhage and edema in 18 cases,vascular dilation,entanglement,and penetration in 15 cases,and pleural traction in 10 cases were founded around lesions.Conclusion:The various histological features of pulmonary cryptococcosis lead to corresponding imaging changes.Understanding of the histological basis of CT imaging changes in pulmonary cryptococcus infection,combined with histological examination of puncture specimens,can avoid overdiagnosis of malignancy and reduce unnecessary surgical treatment.