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[一种罕见的肺部病变关联]

[A rare pulmonary lesion association].

作者信息

Mlika M, Ayadi-Kaddour A, Marghli A, Ridène I, Maalej S, El Mezni F

机构信息

Service d'Anatomie Pathologique, Hôpital Abderrahman Mami, Ariana, Tunisie.

出版信息

Rev Pneumol Clin. 2012 Oct;68(5):303-6. doi: 10.1016/j.pneumo.2012.05.001. Epub 2012 Jul 4.

Abstract

INTRODUCTION

Pulmonary amyloidoma or nodular amyloidosis is a localized form of amyloidosis, which can mimic a bronchopulmonary carcinoma. This form of amyloidosis may be associated to an infectious, a systemic disease or a lymphoma.

OBSERVATION

We describe the case of a 36-year-old patient whose past medical history was consistent for a diabetes mellitus and a hypothyroidism treated by medical treatment. The patient presented a Gougerot-Sjögren syndrome and was explored for non-specific respiratory symptoms. Physical examination was normal. Laboratory tests revealed a monoclonal pic of immunoglobulin. Radiologic findings showed bilateral pulmonary nodules associated to mediastinal lymph nodes. A pulmonary biopsy was performed. Histologic examination revealed a tumoral nodule containing an abundant eosinophilic material, which was acellular and surrounded by a dense lymphomatous infiltrate destroying the pulmonary parenchyma. Histochemical and immunohistochemical study revealed an association of a nodular pulmonary amyloidosis with a MAT pulmonary lymphoma complicating a Gougerot-Sjögren syndrome.

CONCLUSION

The association of MALT pulmonary lymphoma and localized amyloidosis is rarely observed in case of Gougerot-Sjögren syndrome. The pathogenesis of this association remains unknown and the management non-consensual because of the rarity of the cases reported. Whereas, it appears that localized amyloidosis associated to a MALT lymphoma seems to have a better prognosis than a disseminated amyloidosis.

摘要

引言

肺淀粉样瘤或结节性淀粉样变性是淀粉样变性的一种局部形式,可类似支气管肺癌。这种淀粉样变性形式可能与感染、全身性疾病或淋巴瘤有关。

病例报告

我们描述了一名36岁患者的病例,其既往病史符合药物治疗的糖尿病和甲状腺功能减退症。该患者患有干燥综合征,因非特异性呼吸道症状接受检查。体格检查正常。实验室检查发现单克隆免疫球蛋白峰。影像学检查发现双侧肺结节伴纵隔淋巴结肿大。进行了肺活检。组织学检查显示肿瘤结节内含有丰富的嗜酸性物质,该物质无细胞结构,周围有致密的淋巴瘤浸润,破坏肺实质。组织化学和免疫组织化学研究显示结节性肺淀粉样变性与黏膜相关淋巴组织(MALT)型肺淋巴瘤相关,并发干燥综合征。

结论

在干燥综合征患者中,很少观察到MALT型肺淋巴瘤与局限性淀粉样变性的关联。这种关联的发病机制尚不清楚,由于报道的病例罕见,治疗方法也尚无共识。然而,与弥漫性淀粉样变性相比,与MALT淋巴瘤相关的局限性淀粉样变性似乎预后更好。

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