Kaya Akýn, Savaş Ysmail, Sen Elif, Sak Serpil Dizbay, Güngör Adem, Gönüllü Uğur
Service de Pneumologie de l'Hôpital Universitaire d'Ankara, And Sokak 14/6 Cankaya/Ankara 06680, Tùrkiye.
Can Respir J. 2002 Nov-Dec;9(6):431-2. doi: 10.1155/2002/547149.
There exists a rarely observed association between pulmonary histiocytosis X and bronchopulmonary cancer. However, the frequency of bronchopulmonary cancer in these patients is higher than in the general population. A 28-year-old patient who currently smokes ten packs of cigarettes a year came to our department of pneumology with complains of cough and hemoptysis. An x-ray of the thorax revealed bilateral cysts and a shadow in the upper part of the right pulmonary field. In addition, a chest tomography showed multiple cysts dispersed throughout the two pulmonary fields and an irregular mass with a diameter of four centimetres in the upper right lobe. Bronchopulmonary adenocarcinoma was diagnosed during a cytologic exam of the bronchial washing. We decided to perform a thoracotomy on the patient, since there was no far metastasis. An upper lobectomy and wedge resection of the upper segment of the lower right lobe, which had been invaded by the tumour, were performed. Histology confirmed the diagnosis of adenocarcinoma. A pulmonary biopsy was carried out on the tumour-free site and showed the presence of histiocytosis X. There is a hypothesis that a neoplasm developed on the pulmonary fibrosis could be an epiphenomenon of bronchopulmonary cancer in patients who smoke and have pulmonary histiocytosis X. It is interesting to note that histiocytosis X and bronchopulmonary cancer were diagnosed at the same time, since the bronchopulmonary cancer may have occurred within a few years following the diagnosis of histiocytosis X, even if she was a smoker. Hemoptysis, which is found in 5% of patients with histiocytosis X, may suggest cancer. This young patient, a smoker, who complained of hemoptysis, is a particularly rare case of the association between pulmonary histiocytosis X and bronchopulmonary cancer whose pathogenesis is not clear cut. It is thus important to note that smoking can have major consequences, even in young people.
肺组织细胞增多症X与支气管肺癌之间存在一种罕见的关联。然而，这些患者中支气管肺癌的发生率高于普通人群。一名现年28岁、目前每年吸烟10包的患者因咳嗽和咯血前来我院呼吸科就诊。胸部X光显示双侧囊肿以及右肺野上部有一个阴影。此外，胸部断层扫描显示多个囊肿散布于双侧肺野，右上叶有一个直径4厘米的不规则肿块。在对支气管冲洗液进行细胞学检查时诊断为支气管肺腺癌。由于尚无远处转移，我们决定对该患者进行开胸手术。实施了右上叶切除术以及对受肿瘤侵犯的右下叶上段进行楔形切除术。组织学检查证实为腺癌。在无肿瘤部位进行了肺活检，显示存在组织细胞增多症X。有一种假说认为，在吸烟且患有肺组织细胞增多症X的患者中，在肺纤维化基础上发生的肿瘤可能是支气管肺癌的一种附带现象。值得注意的是，组织细胞增多症X和支气管肺癌是同时被诊断出来的，因为支气管肺癌可能在组织细胞增多症X诊断后的几年内发生，即便她是吸烟者。咯血在5%的组织细胞增多症X患者中出现，可能提示癌症。这位主诉咯血的年轻吸烟患者，是肺组织细胞增多症X与支气管肺癌关联的一个极为罕见的病例，其发病机制尚不清楚。因此，重要的是要注意到，即使是年轻人，吸烟也可能产生重大后果。
