Yokoi K, Miyazawa N, Mori K, Saito Y, Tominaga K, Suzuki K
Division of Chest Disease, Tochigi Cancer Center, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1990 Mar;28(3):529-34.
A 58-year-old woman was admitted due to an abnormal shadow on chest X-ray film and two episodes of hemoptysis during the past two years. Chest radiography showed a mass with calcification in the left upper lobe of the lung. A white polypoid lesion in left B3b + c bronchus was discovered by fiberoptic bronchoscopy. Biopsy specimen of the polypoid lesion demonstrated fungi like aspergilli in the necrotic tissue. We suspected pulmonary aspergillosis combined with old tuberculosis and treated with antifungal and antituberculous drugs. After nine months, however, we recognized that the mass had become larger radiologically. A polypoid tumor with a brown, glossy surface in the left B3 bronchus was again noted endoscopically. Histologic findings of the biopsy specimen obtained from this tumor were suggestive of thymoma. Thymectomy and left upper lobectomy were performed. The cross-section of the surgical specimen revealed that the tumor extended not only in the mediastinum but also in the pulmonary parenchyma with polypoid growth into the lumina of bronchi. Microscopically, the tumor was an invasive thymoma composed of both epithelial and lymphocytic elements.
一名58岁女性因胸部X光片出现异常阴影以及在过去两年内发生两次咯血而入院。胸部X光检查显示左肺上叶有一个伴有钙化的肿块。通过纤维支气管镜检查发现左B3b + c支气管内有一个白色息肉样病变。息肉样病变的活检标本在坏死组织中显示出曲霉菌样真菌。我们怀疑是肺曲霉菌病合并陈旧性肺结核，并给予抗真菌和抗结核药物治疗。然而，九个月后，我们发现该肿块在影像学上变大了。再次通过内镜检查发现左B3支气管内有一个表面呈褐色、有光泽的息肉样肿瘤。从该肿瘤获取的活检标本的组织学检查结果提示为胸腺瘤。遂进行了胸腺切除术和左肺上叶切除术。手术标本的横截面显示肿瘤不仅延伸至纵隔，还延伸至肺实质，并呈息肉样生长进入支气管腔。显微镜下，肿瘤为侵袭性胸腺瘤，由上皮和淋巴细胞成分组成。
