Tanvetyanon Tawee, Ratanatharathorn Vorachai, Leopairat Juvady
Department of Medicine, Loyola University Medical Center and Hines Veteran Affair Hospital, Maywood, IL, USA.
J Med Assoc Thai. 2004 Aug;87(8):988-91.
The authors describe a 62-year-old female patient who presented with a progressively enlarging cavitary lesion in the right upper lobe of the lung. Acid-fast bacilli were recovered from a bronchial washing fluid and identified as Mycobacterium tuberculosis. She received antituberculous therapy for 5 months without improvement in her clinical symptoms and chest radiograph. A lobectomy was performed and pathological review demonstrated a high-grade mucoepidermoid lung carcinoma with extensive central necrosis. Staging revealed metastases in her left adrenal gland, kidney and spine. High-grade mucoepidermoid carcinoma of the lung may present as a cavitary lesion. The presence of M. tuberculosis should not preclude clinicians from pursuing adequate diagnostic procedures for a possible malignant lesion.
作者描述了一名62岁女性患者,其右肺上叶出现一个逐渐增大的空洞性病变。从支气管冲洗液中检出抗酸杆菌,鉴定为结核分枝杆菌。她接受了5个月的抗结核治疗,但临床症状和胸部X线片均无改善。随后进行了肺叶切除术,病理检查显示为高级别黏液表皮样肺癌,伴有广泛的中央坏死。分期检查发现其左肾上腺、肾脏和脊柱有转移。高级别肺黏液表皮样癌可能表现为空洞性病变。结核分枝杆菌的存在不应妨碍临床医生对可能的恶性病变进行充分的诊断程序。