双肺多发结节伴间质性改变

Multiple pulmonary nodules with interstitial changes

患者女,53岁,因“发现肺部结节3年余,咳嗽、咳痰伴活动后气短4个月”入院。起初两年半余患者肺部结节影变化不明显,此后结节明显增多伴间质性改变。入院后首先以D‑二聚体明显增高为线索,发现静脉血栓栓塞症(VTE)事件。此后又以VTE查因为线索,完善支气管镜病理、胃镜病理、正电子发射计算机断层显像(PET‑CT)、头部磁共振等检查,最终病理证实为肺腺癌,以实性为主伴黏液分泌型,伴纵隔肺门淋巴结转移、肺内转移、胃转移。肺部及胃部病理组织基因检测均显示EML4‑ALK融合基因阳性,给予患者依次口服克唑替尼、阿来替尼靶向药物以及抗凝等治疗20个月后电话随访,患者诉日常活动无明显受限。

A 53‑year‑old female patient with pulmonary nodules for more than 3 years was admitted to Beijing Chao‑Yang Hospital because of cough and sputum with shortness of breath after exercise for 4 months.In the first two and a half years,her pulmonary nodules remained stable,after that the nodules increased obviously with interstitial changes.After admission,a venous thromboembolic(VTE)event was quickly detected with a marked increase in D‑dimer.Then,based on the clues of VTE examination,bronchoscopy,gastroscope,positron emission tomography‑CT,head magnetic resonance and other examinations were performed.The final pathological diagnosis was lung adenocarcinoma,mainly solid with mucus secretion,with mediastinal hilar lymph node metastasis,intrapulmonary metastasis and gastric metastasis.Gene detection of lung and stomach histopathological tissues showed positive EML4‑ALK fusion gene.The patient received therapies with crizotinib,alectinib in sequence and anticoagulation.After 20‑month treatment,a telephone follow‑up showed that there was no significant limitation in her daily activities.