Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Unexpected diffuse lung lesions in a patient with pulmonary alveolar proteinosis:A case report

BACKGROUND Pulmonary alveolar proteinosis(PAP)often presents nonspecifically and can be easily confused with:(1)Idiopathic interstitial lung fibrosis;(2)alveolar carcinoma;(3)pulmonary tuberculosis;and(4)other lung diseases such as viral pneumonia,mycoplasma pneumonia,and chlamydial pneumonia.CASE SUMMARY Diagnosis:In this case,a patient was diagnosed with PAP through transbronchial cryobiopsy(TBCB)and quantitative metagenomic next-generation sequencing,which confirmed the impairment of surfactant turnover as the underlying cause of PAP.Interventions:High-volume total lung lavage was performed for this patient.Outcomes:The patient's clinical condition had improved significantly by the 6-month follow-up,with a 92%finger oxygen saturation.A repeat chest computed tomography scan revealed scattered patchy ground-glass shadows in both lungs,which was consistent with alveolar protein deposition but with a lower density than in the radiograph from October 23,2022.CONCLUSION TBCB has unique advantages in diagnosing atypical alveolar protein deposition,particularly for enabling the early detection of PAP.This information can help patients take preventive measures to prevent or halt PAP development by avoiding dusty environments and seeking treatment with total lung lavage and inhaled granulocyte macrophage colony-stimulating factor.

Virtual bronchoscopic navigation without fluoroscopy guidance for peripheral pulmonary lesions in inexperienced pulmonologist

Objective:Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath(EBUS-GS)in peripheral pulmonary lesions(PPLs).Virtual bronchoscopic navigation(VBN)can guide the bronchoscope by creating virtual images of the bronchial route to the lesion.The diagnostic yield and safety profiles of VBN without fluoroscopy for PPLs have not been evaluated in inexperienced pulmonologist performing EBUS-GS.Methods:Between January 2016 and June 2017,consecutive patients with PPLs referred for EBUS-GS at a single cancer center were enrolled.The diagnostic yield as well as safety profiles was retrospectively analyzed,and our preliminary experience was shared.Results:A total of 109 patients with 109 lesions were included,99(90.8%)lesions were visible on EBUS imaging.According to the procedure time needed to locate the lesion on EBUS,24.8%(27/109)were deemed technically difficult procedures;however,no significant relationships were identified between candidate parameters and technically difficult procedures.The overall diagnosis yield was 74.3%(81/109),and the diagnostic yield of malignancy was 83.7%(77/92).Lesions larger than 20 mm[odds ratio(OR),2.758;95%confidence interval(95%CI),1.077-7.062;P=0.034]and probe of within type(OR,3.174;95%CI,1.151-8.757,P=0.026)were independent factors leading to a better diagnostic yield in multivariate analysis.About 30 practice procedures were needed to achieve a stable diagnostic yield,and the proportion of technically difficult procedures decreased and stabilized after 70 practice procedures.Regarding complications,one patient(0.9%)had intraoperative hemorrhage(100 mL)which was managed under endoscopy.Conclusions:VBN without fluoroscopy guidance is still useful and safe for PPLs diagnosis,especially for malignant diseases when performed by pulmonologist without previous experience of EBUS-GS.VBN may simplify the process of lesion positioning and further multi-center randomized studies are warranted.

Effects of in vitro cultivated Calculus Bovis compound on pulmonary lesions in rabbits with schistosomiasis

AIM:To explore the interventional effects and mechanism of in vitro cultivated Calculus Bovis compound preparation(ICCBco) on pulmonary lesions in portal hypertensive rabbits with schistosomiasis. METHODS:The experimental group included 20 portal hypertensive rabbits with schistosomiasis treated by ICCBco.The control group included 20 portal hypertensive rabbits with schistosomiasis treated by praziquantel. The morphological changes of the pulmonary tissues were observed under light and electron microscopy.The expression of fibronectin(FN) and laminin(LN) in the lung tissues was analyzed by immunohistochemistry. RESULTS:Under light microscope,the alveolar exudation in the lung tissue was more frequently observed in the control group,while the alveolar space was fairly dry in the lung tissue of ICCBco group.Under electron microscope,more alveolar exudation in the lung tissue,and moremacrophages,alveolar angiotelectasis and the blurred three-tier structure of alveolar-capillary barrier could be seen in the control group.In ICCBco group,fibers within the alveolar interspace slightly increased in some lung regions,and the structure of typeⅠepithelium,basement membrane and endodermis was complete,and no obvious exudation from the alveolar space,and novascular congestion could be observed.There was a positive or strong positive expression of FN and LN in the lung tissue of the control group,while there was a negative or weak positive expression of FN and LN in ICCBco group. CONCLUSION:ICCBco can effectively prevent pulmonary complications in portal hypertensive rabbits with schistosomiasis by means of improving lung microcirculation and lowering the content of extracellular matrix.

Effects of Lianhua Qingwen on Pulmonary Oxidative Lesions Induced by Fine Particulates(PM2.5) in Rats

Objective To investigate the antagonistic effects of different doses of Lianhua Qingwen on pulmonary injury induced by fine particulates PM2.5 in rats. Methods Fine particulates suspended in the environment were collected. Forty-eight healthy adult wistar rats were randomly divided into 6 groups with 8 rats in each group. Four groups of rats were exposed to PM2.5 by intratracheally dripping suspensions of fine particulates PM2.5(7.5 mg/kg) as dust-exposed model rats. Among them 24 rats in three groups received Lianhua Qingwen treatment(crude drug) at a dose of 2 g/kg, 4 g/kg, 8 g/kg per day for 3 days before dust exposure and were defined as low-dose, middle-dose and high-dose Lianhua Qingwen treatment groups respectively. The other dust-exposed model rats without treatment were assigned as PM2.5 control group. The un-exposed rats were set as saline control group(1.5 ml/kg saline) and blank control group. All rats were killed after 24 hours of the exposure. Lung tissue, serum and bronchoalveolar lavage fluid(BALF) were collected. The levels of malonaldehyde(MDA), lactate dehydrogenase(LDH), and glutathione peroxidase(GSH-PX) in blood serum and BALF, and superoxide dismutase(SOD) in blood surum were measured using fluorescent quantitation PCR; Expression of NF-E2-related factor 2(NRF-2), heme oxygenase 1(HO-1) and quinone oxidoreductase 1(NQO1) in lung tissues were measured using Western blot. Pathological changes of lung tissues in each group were also examined. Results Pathology revealed thickened alveolar septum, congestion of capillary, interstitial edema and infiltration of lymphocyte and neutrophil surrounding bronchiole in the PM2.5 control group, which weresignificantly relieved in the Lianhua Qingwen treatment groups. Compared to the blank and saline control groups, the PM2.5 control group had significantly higher levels of LDH and MDA(p<0.01) and lower level of GSH-PS(p<0.01) in BALF, significantly higher levels of LDH and MDA(p<0.05) and lower level of GSH-PS(p<0.05) in rat serum. The levels of MDA in blood serum and BALF were significantly lower in each treatment group than that in PM2.5 control group(all P<0.05). In both middle-dose and high-dose treatment group the measurements of LDH in serum and BALF as well as GSH-PX in serum were significant difference from those of PM2.5 control group(all P<0.05). Expressions of NRF-2, HO-1 and NQO1 in lung tissues were significantly different among middle-dose and high-dose treatment group compared with those in PM2.5 control group(all P<0.05). Conclusion Fine particulates PM2.5 in environment may induce pulmonary oxidative lesions in rats. Middle-dose and high-dose Lianhua Qingwen has antagonist effece on the injuries induced by fine particulates.

Paroxysmal atrial fibrillation ablation:Achieving permanent pulmonary vein isolation by point-by-point radiofrequency lesions

Pulmonary vein isolation by point-by-point radiofrequency catheter ablation constitutes the cornerstone of catheter ablation strategies for the treatment of atrial fibrillation. However, despite advances in pulmonary vein isolation ablation strategies, long-term success rates after ablation remain suboptimal, which highlights the need to develop techniques to achieve more durable lesions. Strategies proposed to improve the durability of pulmonary vein isolation can be divided into two groups: Those addressed to improving the quality of the lesion and those that optimize the detection of acute PV reconnection during the ablation procedure. This manuscript reviews the role and potential benefits of these techniques according to current clinical evidence.

NOTCH3 Mutations and CADASIL Phenotype in Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

Background:The etiology of pulmonary arterial hypertension associated with congenital heart disease(PAHCHD)is complicated and the phenotype is heterogeneous.Genetic defects of NOTCH3 were associated withcerebral disease and pulmonary hypertension.However,the relationship between NOTCH3 mutations and theclinical phenotype has not been reported in CHD-PAH.Methods:We eventually enrolled 142 PAH-CHD patientsfrom Fuwai Hospital.Whole exome sequencing(WES)was performed to screen the rare deleterious variants ofNOTCH3 gene.Results:This PAH-CHD cohort included 43(30.3%)men and 99(69.7%)women with the meanage 29.8±10.9 years old.The pathogenic or likely pathogenic mutations of NOTCH3 were identified in five cases.Patients 2,5,8 and 11 carried the same NOTCH3 mutation c.1630C>T(pArg544Cys),which is the hot-spotmutation for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy(CADASIL).Patient 3 carried the NOTCH3 mutation p.Arg75Gln that has also been reported to be associatedwith the CADASIL.Patients 2,5,8,11 took the examination of the cerebral magnetic resonance imaging(MRI)and confirmed the phenotype of CADASIL.Conclusions:We first reported the NOTCH3 rare mutationsand CADASIL phenotypes in CHD-PAH patients.The NOTCH3 rare variants were with a relatively high positiverate and CADASIL phenotypes were likely enriched in PAH-CHD patients.The preoperative neurological examinationmight be recommended for PAH-CHD patients to determine the surgical contraindications and reduceintraoperative neurological complications.

Robotic-assisted bronchoscopy in the diagnosis of peripheral pulmonary lesions

More peripheral pulmonary lesions(PPLs)are detected by low-dose helical computed tomography(CT)either in-cidentally or via dedicated lung cancer screening programs.Thus,using methods for safe and accurate diagnosis of these lesions has become increasingly important.Transthoracic needle aspiration(TTNA)and transbronchial lung biopsy(TBLB)are routinely performed during the diagnostic workup for PPLs.However,TTNA often car-ries the risk of pneumothorax,uncontrollable airway hemorrhage,and does not allow mediastinal staging in one procedure.In contrast,traditional TBLB often has a poorer diagnostic yield despite fewer complications.With the ongoing development of technology applied to bronchoscopy,guided bronchoscopy has become widely used and the diagnostic yield of TBLB has improved.Additionally,guided bronchoscopy continues to demonstrate a better safety profile than TTNA.In recent years,robotic-assisted bronchoscopy(RAB)has been introduced and imple-mented in the diagnosis of PPLs.At present,RAB has two platforms that are commercially available:Monarch TM and Ion TM;several other platforms are under development.Both systems differ in characteristics,advantages,and limitations and offer features not seen in previous guided bronchoscopy.Several studies,including cadaveric model studies and clinical trials,have been conducted to examine the feasibility and performance of RAB using these two systems;large multicenter studies are underway.In this review,published experimental results,focus-ing on diagnostic yield and complications of RAB,are analyzed and the potential clinical application of RAB is discussed,which will enable the operators to have a clear overview of RAB.

A Bronchopulmonary Onset of Candidemia Revealing a Granulomatosis with Polyangiitis

Candidemia is defined as being a yeast infection confirmed by the presence of at least one positive Candida blood culture. It is a life threatening infection causing high mortality. The clinical signs are generally compatible with the causative agent (whether there is a deep venous catheter or not). On the other hand and according to the 2012 Revised Chapel Hill Classification, granulomatosis with polyangiitis GPA is classified as a vasculitis associated with antineutrophil cytoplasmic antibodies ANCA. It is a systemic disease characterized by the anatomopathological aspect of granuloma. We report the case of a patient who presented an atypical and a very rare revealing mode of GPA which was a bronchopulmonary candidiasis complicated by candidemia. Despite its controversy, the combination in the acute phase of antifungal treatment based on intravenous voriconazole and glucocorticoid therapy has made it possible to control candidemia and calm vasculitis.

DIFFERENTIAL ULTRASONIC DIAGNOSES OF PULMONARY BENIGN AND MALIGNANT SPACE-OCCUPIED LESIONS OF THE PERIPHERAL TYPE

87 patients with pulmonary space-occupied lesions of the peripheral type which were either adhesive of close to pleura were examined using ultuasonography.Of them,64 cases of lung cancers and 23 of bening lesions were then confirmed by

Analysis of clinical and imaging features of Behcet's disease-related pulmonary lesions:a series of eight cases

To the Editor:Behcet's disease is a chronic vascular inflammatory disease that involves multiple systems of the body.Although the incidence of pulmonary damages is low in Behcet's disease,most of them are serious.The initial pulmonary damages of Behcet's disease are mainly manifested with mild cough,chest pain,and slight hemoptysis,which are easily misdiagnosed as pulmonary embolism,pneumonia,or other diseases.

Diagnostic value of thin-slice CT navigation combined with cytology in preoperative bronchoscopy of peripheral pulmonary lesions

Objective To evaluate the diagnostic value of thinsliceCT navigation combined with cytology in routinepreoperative bronchoscopy of peripheral pulmonary lesionsand compare the diagnostic effects of different cytologicalsampling methods. Methods The clinical data ofperipheral lung cancer patients with preoperative bronchoscopyand cytology sampling guided by thin-slice CTfrom May 2015 to July 2016 in Cancer Hospital,ChineseAcademy of Medical Sciences were retrospectively analyzed.The diagnostic accuracy,sensitivity and specificityof different cytological sampling methods for peripheralpulmonary lesions guided by thin-slice CT were compared,the factors affected the diagnostic sensitivity wereanalyzed,and the complications induced by these methodswere observed. Results The diagnostic sensitivity ofthin-slice CT navigation combined with bronchoalveolarlavage for peripheral pulmonary lesions was 39. 1%,andthe positive diagnosis rate was 35. 1%.

Solitary pulmonary nodules： comparison of multi-slice computed tomography perfusion study with vascular endothelial growth factor and microvessel density

Background The solitary pulmonary nodule （SPN） is one of the most common findings on chest radiographs. The objectives of clinical practice are to differentiate malignant nodules from benign nodules in the least invasive way and to make a specific diagnosis. This study was aimed to evaluate the correlation between perfusion imaging features and microvessel density （MVD） and vascular endothelial growth factors （VEGF） in SPNs using multi-slice computed tomography （MSCT）; and to provide the theoretical basis for SPN blood flow pattern and blood flow quantitative features. Also, the study called for the discussion of the method＇s clinical application value in the differential diagnosis of benign and malignant SPNs.Methods Sixty-eight patients with SPN underwent multi-location dynamic contrast enhanced （nonionic contrast material was administrated via the antecubital vein at a rate of 4 ml/s） MSCT. Precontrast and postcontrast attenuations on every scan was studied. Perfusion, peak height, and the ratio of the peak height of the SPN to that of the aorta were analyzed. Perfusion was calculated using the maximum gradient of the time-density curves （TDC） and the peak height of the aorta. The quantitative parameters （perfusion, peak height, ratio of peak height of the SPN to that of the aorta） of the blood flow pattern were compared with MVD and the VEGF expression of immunohistochemistry. Results The perfusion peak heights of malignant （（96.15±11.55） HU） and inflammatory （（101.15±8.41） HU） SPNs were significantly higher than those of benign （（47.24±9.15） HU） SPNs （P 〈0.05, P 〈0.05）. Ratios of SPN-to-aorta of malignant and inflammatory SPNs were significantly higher than those of benign SPNs （P 〈0.05, P 〈0.05）. No significant differences were found between the peak height and SPN-to-aorta ratio of malignant SPNs and inflammatory SPNs （P 〉0.05, P 〉0.05）. The precontrast densities of inflammatory SPNs were lower than those of malignant SPNs （P 〈0.05）. Perfusion values of malignant and inflammatory SPNs were significantly higher than those of the benign SPNs （P 〈0.05, P 〈0.05）. The VEGF positive expressions appeared in 32 patients with malignant SPNs and 2 patients with benign SPNs, and the average value of the MVD was higher in patients with malignant SPNs （36.88±6.76） than in patients with either benign （4.51±0.60） or inflammatory （26.11±5.43） SPNs （P 〈0.05, P 〈0.05）. There were statistically significant correlations between the CT perfusion feature and the MVD. The highest correlation was between the peak height of SPN and the MVD （r=0.657, P 〈0.05）.Conclusions Tumor microvessel density and VEGF expression facilitate the exploration of the pathophysiological basis of CT perfusion in SPNs. Multi-slice CT perfusion has shown strong positive correlations with angiogenesis in SPNs.

同轴活检技术应用于CT引导经皮肺活检对不明原因肺部病变的临床意义

目的探讨同轴活检技术应用于CT引导经皮肺活检对不明原因肺部病变的临床意义。方法选取2015年5月至2019年5月清远市人民医院收治的306例不明原因肺部阴影患者作为研究对象,按照不同活检方式分为实验组(n=154)与对照组(n=152)。实验组采用同轴活检技术,对照组采用单纯针刺活检技术。比较两组手术成功率、并发症发生率、成功手术时间和成功手术接受辐射剂量。结果实验组小结节病灶手术成功率为98.3%,高于对照组的84.5%,差异有统计学意义(P<0.05);实验组深部病灶手术成功率为98.9%,高于对照组的90.7%,差异有统计学意义(P<0.05);实验组气胸、咯血发生率均低于对照组,差异有统计学意义(P<0.05);实验组成功手术时间短于对照组,成功手术接受辐射剂量少于对照组,差异有统计学意义(P<0.05)。结论同轴活检技术应用于CT引导经皮肺活检中对疑难穿刺病灶(小病灶和深部病灶)的手术成功率高于单纯针刺活检技术,可降低气胸和咯血发生率,减少患者接受的辐射剂量,缩短手术时间,且该项技术操作简单,成本低廉,只需在传统的单纯针刺活检技术的基础上附加同轴技术即可,值得临床推广应用。

基于人工智能技术的肺部CT扫描对肺纯磨玻璃结节浸润性病变及浸润程度的诊断价值

目的探讨基于人工智能技术的肺部CT扫描诊断肺纯磨玻璃结节浸润性病变及浸润程度的临床价值。方法回顾性分析2021年9月至2022年9月于天门市第一人民医院行手术治疗并经病理活检证实为肺纯磨玻璃结节的55例患者的临床资料,参考2021年世界卫生组织肺肿瘤新分类,根据病理结果分为非浸润性病变组(n=25,25个结节)与浸润性病变组(n=30,35个结节)。所有患者术前均行肺部CT检查,并利用人工智能系统对肺结节进行定性、定量参数分析。比较非浸润性病变组与浸润性病变组结节CT定性、定量参数;比较微浸润性腺癌、浸润性腺癌患者结节CT定性、定量参数;分析CT定性、定量参数对肺纯磨玻璃结节浸润程度预测的影响因素,并分析其预测效能。结果两组结节形态、分叶征、空泡征、支气管异常征、血管异常征、胸闷牵拉征占比及结节最长径、最短径、平扫CT值比较差异有统计学意义(P<0.05)。浸润性腺癌患者的结节形态规则占比低于微浸润性腺癌患者,分叶征、血管异常征、胸闷牵拉征占比均高于微浸润性腺癌患者,平扫CT值大于微浸润性腺癌患者,差异有统计学意义(P<0.05)。Logistic二元回归分析结果显示,分叶征、空泡征、血管异常征、平扫CT值增加是肺纯磨玻璃结节浸润性病变的危险因素(P<0.05);而分叶征、血管异常征、平扫CT值增加是肺纯磨玻璃结节浸润程度的危险因素(P<0.05)。ROC曲线分析结果显示,血管异常征诊断肺纯磨玻璃结节浸润性病变的效能最高(AUC为0.703,灵敏度92.00%,特异度48.60%),分叶征鉴别诊断肺纯磨玻璃结节浸润程度的效能最高(AUC为0.745,灵敏度75.00%,特异度73.90%)。结论基于人工智能技术的肺部CT扫描诊断肺纯磨玻璃结节浸润性及浸润程度有较高的临床价值,且人工智能技术CT扫描获得的内部血管征参数对诊断结节浸润性病变效能高,分叶征对鉴别诊断结节浸润程度效能更高,值得进一步深入研究。

孤立性肺结节患者恶性病变相关因素分析

目的探讨分析孤立性肺结节(SPN)患者恶性病变相关因素。方法选取2021年10月至2023年10月本院收治的100例SPN患者,根据病理检查结果分为良性组(n=46)、恶性组(n=54)。收集患者基本资料,分析影响恶性SPN的因素。结果恶性组年龄、结节直径、咳嗽、咯血、分叶征、血管集束征、胸膜凹陷征、边界不清、CEA阳性、CYFRA21-1阳性、CA125阳性占比均高于良性组(P<0.05)。Logistic多因素分析显示年龄、结节直径、分叶征、CYFRA21-1阳性为影响恶性SPN的独立危险因素(P<0.05)。结论年龄、结节直径、分叶征、SYFRA21-1为影响恶性SPN的独立危险因素,SPN患者出现上述因素应怀疑恶性病变的可能。

肺部结节性病变临床与病理表现分析

目的:分析肺部结节性病变临床与病理表现。方法:选取2016年1月—2023年7月拟于东台市中医院行外科手术治疗的200例肺部结节性病变患者作为研究对象。对研究对象的切除组织进行病理分析,并分析各类型肺部结节性病变的大体及影像学表现。结果:在200例患者中,良性病变10例(5.00%),良性肿瘤15例(7.50%),前驱腺体病变16例(8.00%),恶性肿瘤159例(79.50%)。恶性肿瘤中浸润性腺癌(包含微浸润性腺癌)127例(79.87%),占比最高,其次为鳞状细胞癌22例(13.84%),小细胞癌8例(5.03%)。前驱腺体病变质地软于良性病变、良性肿瘤、恶性肿瘤,差异有统计学意义(P<0.05);良性肿瘤边界不清占比低于良性病变,前驱腺体病变边界不清占比高于良性肿瘤,恶性肿瘤边界不清占比高于良性病变与良性肿瘤,差异有统计学意义(P<0.05)。结论:肺部结节性病变类型较多,在对肺部结节性病变进行病理诊断时,应结合大体检查、影像学表现及病理特征等综合评估肺结节的良恶性。

Extent of Lung Involvement and Serum Cryptococcal Antigen Test in Non-Human Immunodeficiency Virus Adult Patients with Pulmonary Cryptococcosis

Background： Serum cryptococcal antigen （CrAg） test is the most used noninvasive method to detect cryptococcal infection. However, false-negative CrAg test is not uncommon in clinical practice. Then, the aim of this study was to investigate the factors associated with false-negative CrAg test among non-human immunodeficiency virus （HIV） adult patients with pulmonary cryptococcosis and its clinical features. Methods： One hundred and fourteen non-HIV adult patients with pulmonary cryptococcosis, proven by biopsy, were retrospectively reviewed. Finally, 85 patients were enrolled; 56 were CrAg positive （CrAg＋ group） and 29 were negative （CrAg- group）. It was a cross-sectional study. Then, baseline characteristics, underlying diseases, clinical symptoms, laboratory findings, and chest radiological findings were reviewed and analyzed. Chi-square test was used to analyze categorical variable. Odds ratio （OR） was used to measure correlation. Student＇s t-test was obtained to analyze continuous variable. Results： No difference in baseline characteristics, underlying diseases, clinical symptoms, and laboratory findings were found between two groups （P 〉 0.05 in all）. Nevertheless, diffuse extent lesion was 82.1% in CrAg＋ group and 10.3% in CrAg- group （χ2 = 40.34, P〈 0.001; OR = 39.87）. Conclusions： Among patients with limited pulmonary involvement, a negative serum CrAg does not preclude the diagnosis of pulmonary cryptococcosis. However, among patients with extensive pulmonary involvement, serum CrAg is a useful diagnostic tool for pulmonary cryptococcosis. Furthermore, we also noticed that the untypical and mild presentations with extensive pulmonary lesion might be the features of pulmonary cryptococcosis, which needs further investigation.

肺微小脑膜上皮样结节的临床病理分析及讨论

目的探讨肺微小脑膜上皮样结节(MPMN)临床病理学特征。方法收集2019年4月至2022年9月47例病理诊断为MPMN的病例进行年龄、性别、部位、临床表现、影像学(CT)、伴随疾病、单病灶和多病灶、肿瘤大小等情况进行对比统计分析。临床病理特征方面通过组织学、免疫组化,同时与肺脑膜瘤的鉴别方面进行对比分析。结果47例患者年龄范围36~80岁,平均59.7岁。发生部位:左上9例、左下14例、右上8例、右下14例、右中2例。临床表现为无症状32例、咳嗽8例、胸痛6例、门诊1例无病史,均无发热现象。伴随疾病:浸润性腺癌17例;微小浸润性腺癌20例;良性7例;无伴随疾病3例。影像学(CT):磨玻璃影44例;实性2例,无原始数据1例。吸烟史:其中1例男性有明确吸烟史,其余46例烟史不详。病变:单发40例,占85.1%;多发6例,占12.8%;1例无数据,占2.1%。MPMN是由中等大小的上皮样细胞围绕肺泡腔排列,呈小簇状、漩涡状填充式生长,常伴随肺间质小血管,这些细胞与正常的蛛网膜细胞和脑膜瘤细胞相似,形态学温和,细胞大小中等,呈短梭形或椭圆形,细胞质丰富、嗜酸性,核染色质细腻,核仁不明显,部分细胞可见核内包涵体,Ki-67增殖指数均较低(<2%)。结论MPMN多发于肺下叶,常伴发肺腺癌(78.8%),PR阳性表达率较高(100%),对MPMN目前组织起源情况进行文献学习,明确该病变尚待进一步深入学习研究。

快速现场评价联合超细支气管镜对诊断外周(1/3)肺部感染性病变的应用价值

目的:探讨快速现场评价(ROSE)联合超细支气管镜对诊断外周(1/3)肺部感染性病变的应用价值。方法:选取2022年1—5月郑州大学附属郑州中心医院收治的100例胸部CT检测到外周(1/3)肺部病变大于15周岁的患者作为研究对象,将其随机分为观察组和对照组,每组各50例。观察组患者应用超细支气管镜行肺泡灌洗及经支气管肺活检(TBLB),并使用ROSE技术对肺泡灌洗液、肺活检的标本进行评估,若ROSE结果为阳性,则停止气管镜操作,将肺泡灌洗液、活检标本送检验科及病理科;若ROSE结果为阴性,则重新行肺泡灌洗、TBLB及ROSE判读,若连续3次ROSE结果均为阴性,则在病变部位多点TBLB后将活检标本送病理科,灌洗液送检验科;对照组患者在常规气管镜下行肺泡灌洗、经支气管肺活检后,直接将肺泡灌洗液、活检标本送检验科及病理科。比较两组患者诊断率、气管镜操作时间(观察组包括ROSE时间)、气管镜操作次数、有效致病微生物检出率、病理结果阳性率、并发症发生情况。结果:观察组患者诊断率高于对照组患者,差异有统计学意义(χ^(2)=6.453,P<0.05)。两组患者气管镜操作时间比较,差异无统计学意义(t=-0.040,P>0.05);观察组患者气管镜操作次数大于对照组患者,差异有统计学意义(t=2.225,P<0.05)。观察组患者肺泡灌洗液有效致病微生物检出率大于对照组患者,差异有统计学意义(χ^(2)=6.453,P<0.05)。观察组患者病理结果阳性率大于对照组患者,差异有统计学意义(χ^(2)=6.986,P<0.05)。两组患者均无大咯血、气胸等严重并发症发生。结论:ROSE联合超细支气管镜诊断率高、并发症发生率低,能够提高有效致病微生物检出率及病理结果阳性率,无明显增加气管镜操作时间,对外周(1/3)肺部感染性病变的诊断具有很好的安全性和有效性。