支气管腺样囊性癌误诊原因分析并文献复习

Causes of Misdiagnosis of Bronchial Adenoid Cystic Carcinoma and Literature Review

目的分析支气管腺样囊性癌(ACC)的误诊原因,并总结防范误诊措施。方法回顾性分析2019年3月-2022年4月被误诊的支气管ACC 3例的临床资料,并复习相关文献。结果3例均以喘息加重就诊,均误诊为支气管哮喘。3例均行支气管镜取活组织病理检查确诊为ACC。1例给予气管肿瘤切除术+淋巴结清扫术联合放疗,第2次放疗后要求出院,后按计划于门诊行放疗;1例行支气管镜下气管支架植入术后转上级医院,后续治疗无效死亡;1例行支气管镜下气管肿物消融术后拒绝进一步治疗,目前一般情况可。结论支气管ACC临床少见,患者多以哮喘样症状就诊,容易误诊,临床医生应对此类患者尽早行胸部CT及支气管镜检查,避免误诊误治。

Objective To analyze the causes of misdiagnosis of bronchial adenoid cystic carcinoma(ACC)and to summarize the preventive measures to avoid misdiagnosis.Methods Clinical data of 3 cases of bronchial ACC misdiagnosed from March 2019 to April 2022 were retrospectively analyzed,and relevant literature was reviewed.Results All 3 cases presented with aggravation of wheezing and were misdiagnosed as bronchial asthma.All the 3 cases were confirmed to have ACC by bronchoscopy biopsy.One case received tracheal tumor resection+lymph node dissection combined with radiotherapy.After the second radiotherapy,the patient required to leave the hospital and received radiotherapy in the outpatient department as planned.One patient was transferred to a superior hospital after bronchoscopic stent implantation and died indefinitely after ineffective treatment.One declined further treatment after bronchoscopic ablation of trachea mass,and the current general condition was good.Conclusion Bronchial ACC is rare in clinical practice,and most patients present with asthma-like symptoms,which is more likely to be misdiagnosed.Clinicians should perform chest CT and bronchoscopy as soon as possible for these patients to avoid misdiagnosis and mistreatment.