Shimizu J, Watanabe Y, Oda M, Watanabe S, Hayashi Y, Iwa T, Kamimura R, Takashima T, Nonomura A
Department of Surery (I), Kanazawa University School of Medicine, Ishikawa Prefecture, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1990 Sep;28(9):1252-6.
This paper reports a 73-year-old male case of lung cancer presenting as thin-walled cavity which was suspected to be pulmonary mycosis of the fungus ball type. Routine chest X-ray film showed a thin-walled cavity without a round shadow inside it. CR tomogram taken 2 months after the previous plain chest X-ray film showed an irregular thickening of the cavity wall and a round shadow inside it. Pulmonary mycosis of the fungus ball type was suspected based on the CR tomogram. But chest X-ray CT film taken 1 month after the previous CR tomogram revealed that the entire cavity wall was thickened with irregular convexity and no round shadow was seen in the cavity. Cavitary lung cancer was also suspected based on the findings of X-ray CT film. The surgical specimen, obtained by right upper lobectomy, revealed a moderately differentiated squamous cell carcinoma unaccompanied by pulmonary mycosis in the cavity space. Even in cases suggestive of mycosis, aggressive surgical intervention is recommended in those suspected of malignancy.
本文报告了一例73岁男性肺癌病例，表现为薄壁空洞，最初怀疑为曲菌球型肺真菌病。常规胸部X线片显示薄壁空洞，内无圆形阴影。在前次胸部X线平片2个月后进行的CR体层摄影显示空洞壁不规则增厚，内有圆形阴影。基于CR体层摄影怀疑为曲菌球型肺真菌病。但在前次CR体层摄影1个月后进行的胸部X线CT片显示整个空洞壁增厚，有不规则凸起，空洞内未见圆形阴影。基于X线CT片的表现也怀疑为空洞型肺癌。通过右上叶切除术获得的手术标本显示为中分化鳞状细胞癌，空洞内未伴有肺真菌病。即使在疑似真菌病的病例中，对于怀疑为恶性肿瘤的患者也建议进行积极的手术干预。
