Usuda K, Saito Y, Imai T, Ota S, Sato M, Fujimura S, Tamahashi N
Department of Surgery, Tohoku University, Sendai, Japan.
Acta Cytol. 1990 Sep-Oct;34(5):685-9.
The clinical and cytologic features of a case of inflammatory pseudotumor of the lung are presented. Chest roentgenograms revealed a solitary circumscribed round mass in a nine-year-old boy. The mass was diagnosed as a granulomatous lesion by bronchoscopic brushing cytology. Although smears and cultures of sputum and brushing specimens were negative for tuberculosis, a tuberculin reaction was positive and antitubercular therapy was instituted. Since the mass had grown further after six months of therapy, an open lung biopsy was performed to resect the lesion and establish the diagnosis. Imprint smears of the cut surface of the lesion showed cytologic features similar to those of the brushings: short, spindle-shaped cells with a tendency to be arranged in stori-form patterns against a background of minimal necrotic debris. Histopathology established the final diagnosis of inflammatory pseudotumor, a rare granulomatous lesion radiologically resembling a true tumor. Since this lesion usually occurs in younger patients, inflammatory pseudotumor should be considered in pediatric cases with an intrapulmonary lesion that shows histiocytic spindle-shaped cells in stori-form patterns, but whose smears and cultures test negative for tuberculosis.
本文介绍了一例肺炎性假瘤的临床和细胞学特征。胸部X线片显示一名9岁男孩有一个孤立的、边界清晰的圆形肿块。通过支气管刷检细胞学检查，该肿块被诊断为肉芽肿性病变。尽管痰液和刷检标本的涂片及培养均未发现结核杆菌，但结核菌素反应呈阳性，于是开始进行抗结核治疗。治疗6个月后，肿块进一步增大，遂进行了开胸肺活检以切除病变并明确诊断。病变切面的印片涂片显示出与刷检相似的细胞学特征：短梭形细胞，倾向于以束状形式排列，背景为少量坏死碎屑。组织病理学最终确诊为炎性假瘤，这是一种罕见的肉芽肿性病变，在影像学上类似真正的肿瘤。由于这种病变通常发生在较年轻的患者中，对于肺部有病变、显示组织细胞呈束状排列的梭形细胞、但涂片和培养结核检查为阴性的儿科病例，应考虑炎性假瘤的可能。
