Sakai T, Ikeda T, Nishimura Y, Horinouchi H, Kudo S, Hirayama M, Fukayama M
Department of Surgery, Tokyo Metropolitan Komagome Hospital, Japan.
Kekkaku. 1992 May;67(5):409-12.
A 79-year-old housewife complaining of shortness of breath presented with a LUL mass lesion on chest roentgenogram. Bronchofiberscopic biopsy and curettage revealed adenocarcinoma as well as acid-fast bacilli of Gaffky-4. Further investigations showed increased ESR, CRP levels and positive RF. PPD skin test was positive measuring 55 x 43 mm. A left upper lobectomy with mediastinal lymph node dissection was performed. The mass was in S1+2 and measured 2.7 x 2.5 x 1.5 cm. Histologically caseaous necroses and spotted granulomas of tuberculosis were surrounded by bronchioloalveolar cell carcinoma. Recent discussion concerning the simultaneous occurrence of pulmonary tuberculosis and bronchogenic carcinoma suggests a higher coexistence of both diseases. However, the coexistence of active tuberculosis with carcinoma in the same region, as in our case, is quite rare and suggests an etiological closer relationship between both diseases.
一位79岁的家庭主妇因气短前来就诊，胸部X线片显示左肺上叶有肿块病变。支气管纤维镜活检及刮除术显示为腺癌以及加夫基4级抗酸杆菌。进一步检查显示血沉、C反应蛋白水平升高，类风湿因子阳性。结核菌素皮肤试验阳性，大小为55×43毫米。行左上肺叶切除术及纵隔淋巴结清扫术。肿块位于S1+2，大小为2.7×2.5×1.5厘米。组织学检查显示，结核的干酪样坏死和斑点状肉芽肿被细支气管肺泡细胞癌包围。最近关于肺结核与支气管源性癌同时发生的讨论表明这两种疾病共存的情况更为常见。然而，像我们病例中这样在同一区域活动性结核与癌并存的情况相当罕见，提示这两种疾病在病因学上有更密切的关系。
