Tomioka H, Iwasaki H, Okumura N, Aoki M, Hashimoto K, Ohbayashi C
Department of Respiratory Medicine, Nishi-Kobe Medical Center, Japan.
Nihon Kokyuki Gakkai Zasshi. 1999 Jan;37(1):78-82.
A 54-year-old man was treated with an antifungal agent (itraconazole) for post-tuberculous intracavitary aspergillosis. Though clinical and radiological findings indicated that the patient's symptoms had gone into remission, aspergillosis recurred 4 months after the cessation of antifungal chemotherapy, requiring that the patient undergo an operation. Intraoperative and pathological findings revealed a squamous cell carcinoma contiguous to the cavity containing the aspergilloma. Though a few cases of aspergilloma within cavitating pulmonary carcinomas have been reported in the literature, the case of lung cancer we report was thought to arise from preformed lung scars surrounding a post-tuberculous cavity that contained an aspergilloma. Although conclusive distinctions between neoplasms and fungal infections are difficult to make, careful observation of the radiographic features is necessary when treating patients with fungus ball-type aspergillosis.
一名54岁男性因结核后空洞性曲霉病接受抗真菌药物(伊曲康唑)治疗。尽管临床和影像学检查结果表明患者症状已缓解,但在抗真菌化疗停止4个月后曲霉病复发,患者需要接受手术。术中及病理检查结果显示,与含有曲菌球的空洞相邻处有鳞状细胞癌。虽然文献中已报道了几例空洞性肺癌内曲菌球的病例,但我们报告的这例肺癌被认为起源于结核后空洞周围预先形成的肺瘢痕,该空洞内含有曲菌球。尽管肿瘤与真菌感染之间很难做出明确区分,但在治疗曲菌球型曲霉病患者时,仔细观察影像学特征是必要的。