摘要目的 探讨原发性肺隐球菌病(pulmonary cryptococcosis,PC)的临床表现、病理特征、影像学特点及术前误诊原因.方法 回顾分析1998-2008年上海市中山医院收治的52例PC患者的临床、影像学及病理资料.结果 52例PC患者中,男36例,女16例,年龄17～80岁,中位年龄48岁.临床症状较轻,首发症状依次为咳嗽、咳痰及胸痛等.52例中13例既往有慢性疾病或肿瘤病史,其中肝癌并肝移植术后、糖尿病、结核及慢性活动性肝炎各2例,垂体瘤及结节病各1例,糖尿病合并肝痛及肺结核、糖尿病合并结核性胸膜炎及糖尿病合并高血压各1例.45例患者行胸部CT扫描,其中单发或多发结节团块37例,空洞4例,大叶实变3例,弥漫混合性病变1例;CT诊断为恶性肿瘤27例,肺炎15例,结核3例.49例光镜下表现为肉芽肿性病变,3例表现为纤维结缔组织病灶,Grocott六胺银及黏液卡红染色病灶内均可见新型隐球菌.结论 免疫功能正常者亦有发生PC的可能;临床及影像学表现缺乏特征性,且临床症状与影像学表现不符,易误诊为肺癌、肺炎或肺结核;诊断有赖于病理组织学检杳;CT引导下经皮肺穿刺等非开胸肺切除的方法有助于该病的早期诊断.

abstractsObjective To investigate the clinicopathological and CT features of primary pulmonary cryptococcosis (PC), and its underlying reasons for miadiaguosis. Methods The clinical data and pathological features of 52 cases of PC in Zhongshan Hospital from 1998 to 2008 were retrospectively reviewed. Results The 52 patients consisted of 36 males and 16 females aged from 17 to 80 years, with a median age of 48. The early symptoms were cough, phlegm and chest pain. Thirteen cases had a history of chronic diseases or malignant tumor or liver transplantation, including liver cancer and transplantation (n = 2), diabetes (n=2) , chronic hepatitis (n=2) , pituitary adenoma (n=1), sarcoidosis (n=1) , diabetes concomitant with liver cancer and tuberculosis (n=1), with tuberculous pleurisy (n=1) and with hypertension(n=1). Pulmonary nodules, either solitary or multiple, were the most common CT findings, present in 37 of the 45 cases. Cavitation was found in 4 cases, lobar consolidations in 3 cases, diffuse mixed pattern in 1 case. The CT diagnosis before surgery included malignant tumor(n=27), pneumonia(n=15) or tuberculosis (n=3). Microscopically, cryptococcosis granuloma formation was found in 49 of the 52 cases, and the other 3 showed fibrosis with fungi. Cryptococcosis neoformans was detected in all the cases by mucicarmine and Grocott histopathological examination. Conclusions Chest CT findings of PC in immunocompetent patients show a predominant pattern of localized and mixed lesions. PC does not have any specific clinical manifestations and image findings, and it is difficult to be differentiated from lung cancer, tuberculosis or pneumonia.The correct diagnosis relies on histopathological examination. CT guided percutaneous biopsy is useful in confirming the diagnosis.