以坏死性肉芽肿为表现的肺隐球菌病28例临床影像分析

中国真菌学杂志　 2017, Vol. 12 　Issue (4): 212-215.

以坏死性肉芽肿为表现的肺隐球菌病28例临床影像分析

张丽妍¹, 张冬蕾², 谭晓明¹, 谢惠康³

1. 上海交通大学医学院附属仁济医院南院呼吸科, 上海 201112;
2. 上海交通大学医学院附属仁济医院南院胸外科, 上海 201112;
3. 同济大学附属上海市肺科医院病理科, 上海 200433

收稿日期:2017-01-12 出版日期:2017-08-28 发布日期:2017-08-28
通讯作者: 谢惠康,E-mail:xiehuikang@hotmail.com E-mail:xiehuikang@hotmail.com
作者简介:张丽妍,女(汉族),硕士,住院医师.E-mail:leeyan_516@163.com

Pulmonary cryptococcosis presenting as necrotizing granuloma:a clinicopathologic analysis of 28 cases

ZHANG Li-yan¹, ZHANG Dong-lei², TAN Xiao-ming¹, XIE Hui-kang³

1. Department of Respiratory Medicine, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201112;
2. Department of Thoracic Surgery, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201112;
3. Department of Pathology, Tongji University School of Medicine, Shanghai 200433

Received:2017-01-12 Online:2017-08-28 Published:2017-08-28

摘要/Abstract

摘要：

目的分析以坏死性肉芽肿为病理表现的肺隐球菌病（pulmonary cryptococcosis，PC）的临床、病理及影像学特点，提高对该病的认识，减少误诊。方法回顾分析28例该类病例临床、病理及影像学资料。结果 28例PC患者中，男女各14例，年龄27~68岁。仅1例以咳嗽为首发症状，余无症状。5例既往有慢性疾病或肿瘤病史。所有病例均为结节团块，4例含空洞。所有病例病理表现为坏死性肉芽肿，特殊染色可见新生隐球菌体。结论病理表现为坏死性肉芽肿的PC患者其临床、影像及病理表现具有其特殊性，大部分免疫功能正常，较少出现临床症状。影像学表现均为团块影或结节影，病理组织学表现与结核难以鉴别，极易发生误诊，需要加做特殊染色进一步帮助诊断。

关键词: 坏死性肉芽肿, 隐球菌病, 肺

Abstract:

Objective To improve the understanding of pulmonary cryptococcosis (PC) presenting as necrotizing granuloma and to avoid the misdiagnosis through the analysis on clinical,pathological and radiological characteristics. Methods A retrospective review of the clinicopathologic and radiological records of 28 cases of PC presenting as necrotizing granuloma comfirmed by special stains. Results There were 14 males and 14 females,aging from 27 to 68 years (median,51 years).Twenty-seven cases were asymptomaic while only one had cough.The previous history was chronic disease or cancer in 5 cases.CT scan of all cases showed node mass and four of them had a cavity.All cases were observed as necrotizing granuloma microscopically.Cryptococcus neoformans were seen by grocott hexamine silver and PAS staining. Conclusions The majority of PC patients presenting as necrotizing granuloma had normal immune system.Imaging findings were generally mass or cavity.Naked eye specimens were similar to the cancer.It was hard to distinguish necrotizing granuloma from tuberculosis granuloma unless by special staining.

Key words: necrotizing granuloma, cryptococcosis, pulmonary

中图分类号:

R519.4

张丽妍, 张冬蕾, 谭晓明, 谢惠康. 以坏死性肉芽肿为表现的肺隐球菌病28例临床影像分析[J]. 中国真菌学杂志, 2017, 12(4): 212-215.

ZHANG Li-yan, ZHANG Dong-lei, TAN Xiao-ming, XIE Hui-kang. Pulmonary cryptococcosis presenting as necrotizing granuloma:a clinicopathologic analysis of 28 cases[J]. Chinese Journal of Mycology, 2017, 12(4): 212-215.

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