骨化性气管支气管病10例临床病理分析

Ossifying tracheobronchial disease:a clinicopathologic analysis of ten cases

目的探讨骨化性气管支气管病(TO)的临床特征、影像特点、病理形态及诊断要点。方法回顾性分析10例TO的临床资料、影像特征及病理形态学特点。结果10例中,女性4例,男性6例;年龄39~73岁,平均年龄58.7岁;主要的症状包括咳嗽(8例)、咳痰(8例)、胸闷(2例)。从呈现症状到确诊的时间为7天至120个月,平均2.5个月。胸部CT扫描显示4例患者有气管或支气管壁的不规则改变,纤维支气管镜检查示(3/10)例支气管壁狭窄,(8/10)例管壁可见大小不等的结节突向管腔。光镜下气管支气管黏膜下可见结节状增生的软骨或骨组织,7例可见骨髓,4例黏膜表面上皮鳞状化生。结论TO是一种较少见的良性病变,临床症状不典型,影像诊断阳性率低,纤维支气管镜表现为支气管壁向腔内突出的结节状新生物,组织学黏膜下可见软骨组织或骨组织,伴或不伴髓腔形成,需要临床、影像,纤支镜与病理相结合综合诊断。

Objective To investigate the clinical features,imaging features,pathological morphology and diagnosis of tracheobronchopathia osteochondroplastica(TO).Methods The clinical data,imaging features and pathomorphological features of 10 cases of TO were retrospectively analyzed.Results Among 10 cases,4 cases were female and 6 cases were male,aged 39 to 73 years(mean age 58.7 years).The main symptoms included cough in 8 cases,expectoration in 8 cases and chest tightness in 2 cases.The time from symptoms to diagnosis ranged from 7 days to 120 months,with an average of 2.5 months.Chest CT scans revealed irregular changes in the trachea or bronchial wall in(4/10)patients.Fiberoptic bronchoscopy(FOB)showed bronchial stenosis in(3/10)cases,and nodules of different sizes could be seen protrusion into the lumen in(8/10)cases.Under the microscope,nodular hyperplasia of cartilage or bone tissue was observed under the tracheobronchial mucosa,bone marrow was observed in(7/10)cases,and squamous metaplasia was observed on the mucosal surface in(4/10)cases.Conclusion Ossifying tracheobronchial disease is a relatively rare benign lesion with atypical clinical symptoms and low positive rate of imaging diagnosis.FOB shows nodular neoplasm protruding from the bronchial wall into the lumen.Histologically,cartilage or bone tissue will be found under submucosa,with or without medullary cavity formation,which requires comprehensive diagnosis of clinical,imaging,fiberoptic bronchoscopy and pathology.