Field S, Powell F C, Young V, Barnes L
Department of Dermatology, Mater Misericordiae Hospital, Dublin, Ireland.
Clin Exp Dermatol. 2008 Jul;33(4):418-21. doi: 10.1111/j.1365-2230.2008.02756.x. Epub 2008 May 21.
We present a case of pyoderma gangrenosum (PG) mimicking a lung carcinoma. A 52-year-old woman presented with an unremitting cough. Computed tomography revealed a cavitating lung lesion. Bronchoscopy and biopsy were interpreted as squamous cell carcinoma. Following a staging mediastinoscopy, a sleeve lobectomy and chest-wall resection was performed. The pulmonary histopathological features suggested Wegener's granulomatosis; no malignancy was found. Three months postoperatively, wound breakdown led to dermatological review. A clinical diagnosis of cutaneous PG was made on the basis of the classic appearance of the surgical wounds and an ulcer on the upper back that had been present before surgery. The patient has been consistently negative for cytoplasmic-staining antineutrophil cytoplasmic antibodies, which supports the diagnosis of PG with cutaneous and pulmonary involvement. Lung manifestations of PG are rare. PG is amenable to systemic therapy. Pulmonary PG is a rare but important differential diagnosis that is not familiar to many physicians and surgeons in this type of presentation.
我们报告一例误诊为肺癌的坏疽性脓皮病（PG）病例。一名52岁女性因持续咳嗽就诊。计算机断层扫描显示肺部有空洞性病变。支气管镜检查及活检结果诊断为鳞状细胞癌。在进行分期纵隔镜检查后，实施了袖状肺叶切除术及胸壁切除术。肺部组织病理学特征提示韦格纳肉芽肿；未发现恶性肿瘤。术后三个月，伤口裂开促使进行皮肤科检查。根据手术伤口的典型表现以及术前就已存在的上背部溃疡，做出了皮肤PG的临床诊断。该患者的细胞浆染色抗中性粒细胞胞浆抗体始终为阴性，这支持了伴有皮肤和肺部受累的PG诊断。PG的肺部表现较为罕见。PG适合进行全身治疗。肺部PG是一种罕见但重要的鉴别诊断，许多内科医生和外科医生对这种表现形式并不熟悉。
