Watanabe Hidehiro, Uruma Tomonori, Seita Ikuo, Oishi Tsuyoshi, Watanabe Yusuke, Tsukimori Ayaka, Haga Yoshiteru, Fukushima Shinji, Sato Akihiro, Nakamura Itaru, Matsumoto Tetsuya
Department of Infection Control and Prevention, Tokyo Medical University Hospital, Tokyo 160-0023, Japan.
Department of Infection Control and Prevention, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki 300-0395, Japan.
Mol Clin Oncol. 2017 Jun;6(6):839-845. doi: 10.3892/mco.2017.1244. Epub 2017 May 8.
Solitary pulmonary caseating granulomas (SPCGs) are a characteristic type of tuberculomas associated with infection with non-tuberculous mycobacteria (NTM) and other microbes; however, their significance remains unclear. The aim of the present study was to describe the clinical characteristics of patients with SPCGs in terms of diagnosis, presence of lung cancer and treatment status. A retrospective analysis of 17 immunocompetent patients with histopathologically confirmed caseating granulomas after undergoing video-assisted thoracoscopic surgery (VATS) was conducted at our center between 2011 and 2015. The patients comprised 10 men and 7 women with a mean age of 59.1±14.4 years. Of the 17 patients, 14 (82.4%) were asymptomatic and the lesions were discovered incidentally. In 2 patients the SPCGs were accompanied by a small satellite nodule (SPCG mean diameter, 16.2±5.1 mm). Mycobacteria, including (11.8%), (11.8%) (23.5%) and other spp. (5.9%), were isolated from 9 of the patients (52.9%). Concurrent lung cancer was present in 3 patients (17.6%). When microbial agents could not be isolated, the interferon-γ release assay was useful for diagnosis. Positron emission tomography was not found to be useful for differentiating SPCGs from lung cancer, or for differentiating tuberculomas from NTM pulmonary nodules (NTMPNs). NTMPNs in cases of SPCGs were diagnosed more frequently in men. The findings indicate that a course of observation may be sufficient for patients in whom an SPCG from NTM (NTMPN) is identified by VATS. However, the presence of concurrent lung cancer in certain cases indicates that malignancy should not necessarily be excluded, particularly in NTMPNs, and highlights the necessity of aggressive diagnosis by VATS.
孤立性肺干酪样肉芽肿（SPCGs）是一种与非结核分枝杆菌（NTM）及其他微生物感染相关的特征性结核瘤类型；然而，其意义仍不明确。本研究的目的是从诊断、肺癌存在情况及治疗状态方面描述SPCGs患者的临床特征。2011年至2015年期间，我们中心对17例经组织病理学证实为干酪样肉芽肿且免疫功能正常的患者进行了回顾性分析，这些患者均接受了电视辅助胸腔镜手术（VATS）。患者包括10名男性和7名女性，平均年龄为59.1±14.4岁。17例患者中，14例（82.4%）无症状，病变为偶然发现。2例患者的SPCGs伴有小卫星结节（SPCG平均直径为16.2±5.1mm）。从9例患者（52.9%）中分离出分枝杆菌，包括鸟分枝杆菌（11.8%）、胞内分枝杆菌（11.8%）、脓肿分枝杆菌（23.5%）及其他分枝杆菌属（5.9%）。3例患者（17.6%）同时存在肺癌。当无法分离出微生物病原体时，干扰素-γ释放试验有助于诊断。正电子发射断层扫描未发现对鉴别SPCGs与肺癌，或鉴别结核瘤与NTM肺结节（NTMPNs）有用。SPCGs病例中的NTMPNs在男性中诊断更为频繁。研究结果表明，对于通过VATS确诊为NTM来源的SPCG（NTMPN）患者，观察一段时间可能就足够了。然而，某些病例中同时存在肺癌表明不一定能排除恶性肿瘤，尤其是在NTMPNs中，这突出了通过VATS进行积极诊断的必要性。
