摘要
目的探讨肺原发性隐球菌病的肺组织病理学特征、影像学表现及鉴别诊断。方法收集2011年-2018年广东医科大学附属医院确诊并收治的30例肺原发性隐球菌病患者临床资料,对其肺组织病理学特征(HE及特殊染色)、影像学检查等进行回顾性分析。结果 30例肺原发性隐球菌病中,男性18例,女性12例,年龄24~73岁,中位年龄55岁。临床症状多以咳嗽、咳痰、咳血为主;胸部X线检查常常表现为肺小结节影(19例),部分表现为分叶状或片状影(11例);CT检查常表现为肺不规则结节及类结节病变(22例),部分患者呈散在斑片状、磨玻璃样阴影伴小空洞形成(8例)。肺组织大体特征常不明显,肺组织切片HE染色后低倍镜观察呈肥皂泡样改变,高倍镜下可查见圆形或卵圆形的真菌,伴周围空晕形成,偶见上皮样肉芽肿形成及含有菌体的多核巨细胞;免疫组化现为PAS染色阳性、六胺银染色阳性均为97%,抗酸染色阴性率100%。结论肺原发性隐球菌病临床表现及影像学检查多无特异性,易误诊,通过肺组织病理学检查及特殊染色检查对该病的诊断具有重要意义。
Objective To investigate the clinicopathological features of primary pulmonary cryptococcosis in lung tissues, imaging findings, and differential diagnoses. Methods Clinical data on 30 patients with primary pulmonary cryptococcosis seen at the Hospital Affiliated with Guangdong Medical University from 2011 to 2018 were retrospectively analyzed. Clinical pathological features(HE and special staining) and imaging studies were retrospectively analyzed, and a large amount of the relevant literature was retrieved and reviewed. Results Of the 30 patients with pulmonary cryptococcosis, 18 were males and 12 were females. Patients ranged in age from 24 to 73 years(median: 55 years). The main clinical symptoms of pulmonary cryptococcosis were coughing, phlegm, and hemoptysis. Chest X-rays often revealed small nodules(19 patients), though some revealed partly lobulated or patchy opacities(11 patients). CT scans often revealed irregular nodules and nodular-like lesions(22 patients);8 patients had scattered patchy and ground-glass opacities with small voids. A clinicopathological examination revealed no obvious general features in lung tissue. An appearance similar to soap bubbles was observed in HE staining under low-power microscopy. Round or oval cells were observed in HE staining under high-power microscopy along with formation of a surrounding halo, occasional epithelioid granuloma formation, and multinucleated giant cells containing yeast cells. In immunohistochemical staining, PAS staining and hexamine silver staining were positive(97%) while acid-fast staining was entirely negative. Conclusion Primary cryptococcosis of the lung is easily misdiagnosed due to the lack of specific clinical manifestations and imaging findings. A pathological examination and special staining are crucial to diagnosing primary cryptococcosis of the lung.
作者
邸小青
甘思远
叶瑞芳
谢东起
刘旺
陈俊虎
黄剑
孙艳芹
DI Xiao-qing;GAN Si-yuan;YE Rui-fang;XIE Dong-qi;LIU Wang;CHEN Jun-hu;HUANG Jian;SUN Yan-qin(Department of Pathology, Guangdong Medical University, Clinical Diagnosis and Research Center, Guangdong Medical University Hospital,Dongguan,Guangdong,China 523808;Ultrasonography, Second Hospital Affiliated with Guangdong Medical University,Zhanjiang,Guangdong,China 524000;Respiratory Medicine, Second Hospital Affiliated with Guangdong Medical University,Zhanjiang, Guangdong , China 524000;Guangdong Provincial Institute of Biological Products and Materia Medica,Guangzhou, Guangdong China 510440)
出处
《中国病原生物学杂志》
CSCD
北大核心
2019年第6期639-642,共4页
Journal of Pathogen Biology
基金
国家自然科学基金项目(No.81702285)
广东省自然科学基金项目(No.2016A030313822)
广东省医学科研基金项目(No.A2017330)
广东医科大学博士启动项目(No.B2017006)
关键词
肺隐球菌病
影像学表现
临床特征
组织病理学
Pulmonary cryptococcosis
imaging findings
clinical features
pathology
