Toma Claudia Lucia, Dumitrache-Rujinski Stefan, Belaconi Ionela Nicoleta, Paraschiv Bianca, Alexe Mihai, Serbescu Aneta, Leonte Diana, Bogdan Miron Alexandru
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; "Marius Nasta" Institute of Pneumology, Bucharest, Romania.
Maedica (Bucur). 2013 Mar;8(1):30-3.
Sarcoidosis is a multisystem inflammatory disease of unknown etiology, characterized by noncaseating epithelioid cell granulomas. In sarcoidosis, the most common radiological findings are mediastinal and bilateral hilar lymph node enlargement. We present a case of sarcoidosis with a rare radiological aspect of pulmonary hilar tumor mass.A 54-year-old female patient, active smoker (40 packs/year), with a history of cutaneous lupus, was admitted in our institute for progressive dyspnea and dry cough. At admission physical examination and laboratory tests were normal. Pulmonary function tests diagnosed an obstructive syndrome. Chest X-ray showed a tumor mass of the right pulmonary hilum. Transbronchial biopsy was nondiagnostic. HRCT-scan showed a tumor mass in the right hilum, which raised the suspicion of a lung cancer. PET-CT scan revealed a high metabolic activity of the tumor mass and of a paratracheal right lymphadenopathy. Lymph node biopsy by mediastinoscopy showed noncaseating epithelioid-cell granulomas, sustaining the diagnosis of sarcoidosis. The outcome was favorable, with spontaneous remission without treatment, but with a relapse that responded after systemic corticotherapy.In conclusion, even if a tumor mass in the pulmonary hilum is highly suggestive of lung cancer, a positive diagnosis should be made only after histological examination, because other benign conditions, like sarcoidosis, could have such an aspect.
结节病是一种病因不明的多系统炎症性疾病，其特征为非干酪样上皮样细胞肉芽肿。在结节病中，最常见的放射学表现是纵隔和双侧肺门淋巴结肿大。我们报告一例具有罕见放射学表现——肺门肿瘤样肿块的结节病病例。一名54岁女性患者，有长期吸烟史（每年40包），有皮肤狼疮病史，因进行性呼吸困难和干咳入住我院。入院时体格检查和实验室检查均正常。肺功能测试诊断为阻塞性综合征。胸部X线显示右肺门有一个肿瘤样肿块。经支气管活检未明确诊断。高分辨率CT扫描显示右肺门有一个肿瘤样肿块，这引发了对肺癌的怀疑。PET-CT扫描显示肿瘤样肿块及右气管旁淋巴结有高代谢活性。经纵隔镜进行的淋巴结活检显示非干酪样上皮样细胞肉芽肿，支持结节病的诊断。结果良好，未经治疗自发缓解，但复发后经全身皮质激素治疗有反应。总之，即使肺门处的肿瘤样肿块高度提示肺癌，但只有在组织学检查后才能做出肯定诊断，因为其他良性疾病，如结节病，也可能有这样的表现。
