CAJ | 학술논문

目的：探讨伴上皮样肉芽肿反应的肺上皮性恶性肿瘤的临床病理学特征。方法对11例肺上皮性恶性肿瘤伴上皮样肉芽肿反应的临床资料进行回顾性分析；根据肺肿瘤组织学类型、免疫表型、抗酸染色和结核PCR检测结果,并结合随访资料进行总结。结果患者平均年龄62．3岁,男女之比为10∶1。临床主要表现为咳嗽、胸痛、发热、咯血等。术前临床诊断肺癌9例,肺结核和炎性病变各1例。全部肿瘤病灶的上皮样肉芽肿反应病变与肿瘤在同一部位(混合存在),病理组织学表现为上皮样或典型结核样肉芽肿形态,其中腺癌4例,鳞癌5例、神经内分泌肿瘤2例。11例中3例抗酸染色找到抗酸杆菌,6例结核分枝杆菌PCR检测阳性。5例术后2年内因不同原因死亡。结论伴上皮样肉芽肿反应的肺上皮性恶性肿瘤多见于中老年人,临床表现为肺癌征象,预后差,明确病变性质需依赖病理活组织检查。重视该类病变(尤其病灶穿刺样本)的病理检查与鉴别诊断,对明确诊断及治疗极其重要。
목적：탐토반상피양육아종반응적폐상피성악성종류적림상병이학특정。방법대11례폐상피성악성종류반상피양육아종반응적림상자료진행회고성분석；근거폐종류조직학류형、면역표형、항산염색화결핵PCR검측결과,병결합수방자료진행총결。결과환자평균년령62．3세,남녀지비위10∶1。림상주요표현위해수、흉통、발열、각혈등。술전림상진단폐암9례,폐결핵화염성병변각1례。전부종류병조적상피양육아종반응병변여종류재동일부위(혼합존재),병리조직학표현위상피양혹전형결핵양육아종형태,기중선암4례,린암5례、신경내분비종류2례。11례중3례항산염색조도항산간균,6례결핵분지간균PCR검측양성。5례술후2년내인불동원인사망。결론반상피양육아종반응적폐상피성악성종류다견우중노년인,림상표현위폐암정상,예후차,명학병변성질수의뢰병리활조직검사。중시해류병변(우기병조천자양본)적병리검사여감별진단,대명학진단급치료겁기중요。
Purpose To investigate the clinicopathologic changes of the lung epithelial tumor with epithelioid granuloma. Methods E-leven cases of lung malignant tumor with epithelial epithelioid granuloma reaction were studied according to the histological changes of lung epithelial tumor, immunophenotype, acid-fast staining, and tuberculosis PCR test results combined with follow-up data. Results The mean age was 62. 3 years, and male to female ratio was 10∶ 1. The main clinical manifestations displayed a cough, chest pain, fever and hemoptysis or bloody sputum. Nine cases were malignant tumors, tuberculosis or inflammatory lesions was 1 case each in pre-vious surgery. The tumor with epithelioid granuloma formation of the 11 cases displayed in the same site ( mixed) . The histopathologic changes of the lesions showed a epithelioid or typical tuberculous granulomas formation, including 4 cases of adenocarcinoma, 5 cases of squamous cell carcinoma and 2 cases of neuroendocrine tumors. The acid-fast bacilli staining was positive in 3 cases;6 cases were positive for PCR detection of mycobacterium tuberculosis. 5 patients died within 2 years due to various causes. Conclusions The lung epithelial tumors with epithelioid granuloma is more commonly found in the middle-aged, The signs and symptoms of the patients are similar to primary epithelial malignant tumors of the lung . The biological behavior was progressive with poor prognosis. The diagnosis of the lesions depends on pathological examination. It is very important to pay more attention to the pathological examination, especially in lung puncture samples, and the differential diagnosis for a definate diagnosis and treatment.